THE RESPIRATOR.

It is unnecessary for us to speak in favour of this ingenious and invaluable instrument. The experience of the profession has established its eminent utility as a preventive, if not also as a curative means. But we are anxious to introduce to our readers some modifications which its able inventor, Mr. Jeffreys, has made in it. First, the large sale, and improvements in the manufacture have enabled him to construct a cheap, yet most efficient instrument for the poor. The mechanic or the labourer may now obtain one for the low sum of seven shillings; while for females the price is only six shillings. This is an inestimable boon to the less affluent classes. It is unnecessary to point out the benefits that must accrue to many a family, from the head of it being enabled to pursue the occupation on which his and their subsistence depends. Secondly, a less important, yet not contemptible alteration has been made in the construction of the more expensive instruments. A light kind of scarf has been attached to the front by which the bizarrerie of their appearance is removed. patients, at all events, will bless Mr. Jeffreys for this. In conclusion, we would entreat our professional friends to avail themselves of this admirable adjuvant to their previous stock of remedies.

Our fair

BIBLIOGRAPHICAL RECORD.

AN ATLAS OF PLATES ILLUSTRATIVE OF THE PRINCIPLES AND PRACTICE OF OBSTETRIC MEDICINE AND SURGERY. WITH DESCRIPTIVE LETTER PRESS. By Francis H. Ramsbotham, M.D. Member of the Royal College of Physicians, Physician to the Royal Maternity Charity, and Lecturer on Obstetric and Forensic Medicine at the London Hospital, &c. London: J. Churchill, 1840. Parts IV., V., and VI.

This is really a very meritorious, and likely to prove a very useful work. The Parts are published with regularity, and their execution is equal to that of their predecessors. The Plates are extremely good.

The commencement of the Fourth Part is occupied with the description of the decidua, and the ovum with its accompaniments. The description of "Labour" is then taken up and pursued through the succeeding Parts.

We observe that Dr. Ramsbotham doubts, as most anatomists of the present day do, the accuracy of Hunter's view of the mode of formation of the "Decidua Reflexa." For, as he observes, a prolongation of the outer membrane has been frequently observed passing a little way into each Fallopian tube, which could not be the case were the internal merely a duplicature of the outer layer.

We beg to reiterate our favorable opinion of the Work, and to wish its zealous and talented author every possible success.

1. Dictionary of Geology and Mineralogy, comprising such terms in Botany, Chemistry, Comparative Anatomy, Conchology, Entomology, Paleeontology, Zoology, and other Branches of Natural History, as are connected with the Study of Geology. By William Humble, M.D. Octavo, pp. 279. In closely-printed double columns. Washbourne, Salisbury-Square, Fleet Street. March, 1840.

2. A Series of Anatomical Sketches and Diagrams, with Descriptions and References. By Thomas Wormald, Assistant Surgeon and Demonstrator of Anatomy at St. Bartholomew's Hospital, and Andrew Melville McWhinnie, Teacher of Practical Anatomy at St. Bartholomew's Hospital. Quarto, pp. 16. Price 4s. No. 2. Highley, 1840.

3. The India Journal of Medical and Physical Science for August, September, and December, 1840. In exchange, the India Review for same months.

4. Statistical Reports on the Sickness, Mortality, and Invaliding among the Troops in Western Africa, St. Helena, the Cape of Good Hope, and the Mauritius. Prepared from the Records of the Army Medical Department and War-Office Returns. Presented to both Houses of Parliament. 4to, 1840. Presented to the Senior Editor, by Sir James M' Gregor.

5. First Principles of Surgery; being an Outline of Inflammation and its Effects. By George T. Morgan, A.M. formerly Lecturer on Surgery in Aberdeen. Part 3, 1840. Highley, Fleet street. Maclachlan and Stewart, Edinburgh.

10. Parochial Medical Relief considered in a letter to the "Poor-Law Commissioners," developing an entirely new System of Medical Remuneration, alike conducive to the Interests of the Rate-Payers, the well-being of the Poor, and the respectability of the Profession. By E. D. Mere dith, M.R.C.S. Octavo, pp. 35. Price 1s. 6d. Highley, Fleet street. May. 1840.

11 Observations on the Diseases inciden to Pregnancy and Childbed. By Fleetwood Churchill, M.D., &c. &c. Octavo pp. 463. Keene and Son, Dublin. May, 1840.

12. Memoir on Extra-uterine Gestation. By Dr. Wm. Campbell, of Queen's College, Edinburgh, &c. Octavo, pp. 154. Black and Co. Edinburgh; Longman,

6. The Phrenological Journal for April, London. May, 1840. 1940. In exchange.

7. Odontography; or a Treatise on the Comparative Anatomy of the Teeth, their Physiological Relations, Mode of Development, and Microscopic Structure, in the Vertebrate Animals, illustrated by upwards of 150 plates. By Richard Owen, FR.S. Hunterian Professor to the Royal College of Surgeons, &c. Part the First, containing seven sheets of letter-press, and fifty plates. London, Bailliere; Paris, Bailliere; Leipzig, Wergel, 1840. Price, plain plates, 1.11s. 6d. Quarto proofs, 21. 12s. 6d.

8. Guy's Hospital Reports, No. X. April 1840. Edited by Drs. Barlow and Babington. Octavo. Highley, 1840.

9. A System of Practical Medicine, comprised in a Series of Original Dissertations. Arranged and edited by Alex. Tweedie, M.D. F.R.S. fc. Vol. I. pp. 440. Very close type. Whittaker, 1840.

This volume contains, "Introduction," Dr. Symonds-" Inflammation," by Dr. Alison-" General Doctrine of Fever," by

Dr. Christison-" Continued Fever," Ditto-" Plague," Dr. Shapter—“ Intermittent Fever," Ditto-" Remittent Fever," Ditto-" Yellow Fever," Ditto-" Infantile Gastric Fever," Dr. Locock-"Hectic Fever," Dr. Christison-" Small-pox," Gregory" Measles," Dr. George Burrows Scarlatina," Ditto-" Puerperal Fevers," Dr. Locnck-" Diseases of the Skin," Dr. H. E. Schedel.

Dr.

13. An Address delivered at the Anniversary Celebration of the Birth of Spurzhiem, and the Organization of the Boston Phrenological Society, December 31, 1839. By George Coombe, Esq. Boston, 1840.

This as might be expected, is an eloquent address, with a dash of enthusiasm.

14. A letter to Sir Benjamin Brodie, Bart., containing a Critical Enquiry into his "Lectures illustrating certain local Nervous Affections." By William Goodlad, M.R.C.S. &c. &c. Octavo, pp. 154. Longman and Co. May, 1840.

15. An Essay on the Treatment and Cure of Pulmonary Consumption. By George Bodington,Surgeon. Duodecimo, pp. 60. Longman and Co. May, 1840.

16. A Practical Work on the Diseases of the Eye, and their Treatment, Medically, Topically, and by Operation. By Fred. Tyrrell, Senior Surgeon to the Royal London Ophthalmic Hospital, Surgeon to St. Thomas's Hospital, &c. Two Volumes, 8vo, with plates. Churchill, London. May, 1840.

17. A Treatise on the Physiological and Moral Management of Infancy. By And. Combe, MD. Octavo, pp. 374. Maclachlan and Stewart, Edinburg. 1840.

EXTRA-LIMITES.

OBSERVATIONS ON THE OXIDE of Silver; anD AN ABSTRACT OF THE CASES IN WHICH IT HAS BEEN ADMINISTERED. By C.H.B.Lane, Esq. THE use of silver as a medicinal agent is of ancient date. By Avicenna it was given in the metallic form, as a remedy for palpitation of the heart and fætid breath. Takennius used it combined with the cinnabar of antimony in melancholia, epilepsy, and mania. By Angelus Sala it was highly spoken of in the treatment of cerebral and uterine diseases. Mereat has recommended nitrate of silver strongly, as a remedy for hysteria and epilepsy, and relates a case of the latter of thirty years' standing, in which it effected a cure. It is not as much resorted to for internal administration as it was some years back, when its use was sanctioned by the names of Nord, Sprengel. Butini, Esquirol, Lombard, Baillie, Sims, and others. There are, however, still some advocates for its use in epilepsy and gastric affections, most especially Dr. James Johnson; and it has been given in dysentery and cholera. In 1836, M. Serre, of Montpellier, strongly recommended the various salts of silver, and also the oxide, as antisyphilitics, but the evidence he advances of their utility does not appear satisfactory on his own showing, and M. Ricord's report on the subject is unfavourable.

The nitrate has been the form in which silver has been mostly employed; we owe it to alchymical research which, though futile as to its immediate object, has had the beneficial result of affording us numerous powerful weapons wherewith to combat disease. As a local application it is in very general use it acts chemically as a caustic, and is supposed to possess peculiar stimulant powers in addition, which opinion was originally advanced by Mr. Higginbottom, whose work is, I believe, the only English monograph on the subject which we possess. In the present day there has been some tacit acknowledgment of a contra-stimulant influence, but it is vague and undefined. I do not believe nitrate of silver to possess any stimulant action beyond that connected with its causticity; any destructive process tends to excitement if reaction takes place, and will be indicated by pain, that vigilant sentinel of our corporeal welfare. The action of silver I consider as directly sedative as that of lead, only differently evinced. While the primary sedative action of lead is on the nerves of animal life, perhaps that of silver is in special relation to those of organic life, by which the capillary circulation is believed to be governed-this refers to the primary effect, for once the constitution affected, the sedative impression is conveyed to the nervous centres, and the further results may be varied. We will take a case of morbid vascular action occurring in a cutaneous surface, with a view to contrast the respective therapeutic action of lead and silver. We find the application of acetate of lead attended by diminution of sensation, and if the surface be at all abraded, some degree of pain may ensue from the contact of the foreign body, as also from the stimulation of the free acetic acid. The continued application of the lead may annihilate the sensation of the part, and that safeguard of the surface being destroyed, organic life is but too readily arrested, an evil to be carefully avoided. Suppose, on the other hand, we apply the nitrate of silver to what is termed an inflamed surface. It acts primarily as a caustic, becoming decomposed and combining with albumen, first as a chloride, and subsequently as an oxide, constituting a foreign body which protects the surface from external impressions, a mechanical effect well described by Higginbottom; and this process is attended with more or less pain in proportion to No. 81.

25

the liability of the surface to impression either from abrasion or excited sensibility slight organic action even may ensue, causing serous effusion. The excitement, however, generally quickly disappears, and a distinct therapeutic action is evinced. The morbid state, whether demonstrated in increased capillary circulation, secretion, or absorbtion, subsides; when the affection is local it is often quickly subdued. In the incipient stage of anthrax there is no local application which equals nitrate of silver in efficacy in several cases where freely applied, I have seen it arrest the local mischief which there was every reason to suppose would have otherwise gone through the tedious process of sloughing-suppuration and ulceration-and this was what induced me first to suspect that more than mere stimulation took place. Looking at the medicinal influence of nitrate of silver in erysipelas, and various forms of ulcer, in which the existence of excitement to a greater or less extent cannot be denied, I think we shall be still further inclined to lay aside the theory of mere stimulation.

The previous causticity of the lunar caustic is most advantageous in many cases, as for example, in the application to chancres and in chronic ophthalinia, where the destruction of morbid growth is desirable before there can be any susceptibility of sedative impression. There appears but little doubt that the application of nitrate of silver to syphilitic sores, if adopted while the affection is yet local, may preclude the necessity of constitutional remedies by destroying the centre of morbid action. Yet, on the other hand, the production of the sedative effect alone is often more advantageous, for where the organization is weak, the primary destructive causticity is badly borne, though, despite that inconvenience, nothing has been hitherto substituted which will as completely answer the purpose as lunar caustic carefully applied.

The question now is-can the caustic stimulation be voided, and a simple sedative action be instituted through the agency of silver?-to this I would reply in the affirmative! I would recommend the substitution of the oxide for the nitrate, which stands in the same relation thereto as the oxides of antimony and mercury do to tartar emetic and corrosive sublimate respectively. Thus we shall have a mild and manageable preparation-entirely devoid of causticity, which my brief experience leads me to hope will be found of high utility both as a local and internal medicament.

I have applied an ointment of oxide of silver with decided effect in the various stages of gonorrhoea, and with but little inconvenience, beyond what might be fairly attributed to the mere mechanical irritation of the bougie. Over the nitrate it has the great advantage of not producing the caustic irritation by which, at the same time that the morbid secretion may be arrested by a process resembling tanning of the urethral lining membrane, there is considerable additional probability that metasis of the irritation will ensue. The application of the oxide of silver, on the other hand, may be resorted to so as gradually to subdue the disease. I would not, however, by any means recommend its em ployment during the very acute stage while much constitutional irritation exists, and subsequently, only as an auxiliary to the usual medicinal treatment. In chancres, I am convinced that I have seen the most beneficial results attend the application of the ointment. I have often found the sanative effect surprisingly accelerated after the failure of other remedies, and its use is not attended with pain. It is the oxide of silver which exists in Mr. Guthrie's black ointment, named by some "infernal" though far from violent in its action, and I believe available to a much greater extent than usually supposed. His formula consists of teu grains of nitrate of silver, fifteen drops of solution of lead, and a drachm of lard. The oxidization is effected by trituration and exposure to the atmos phere and light. A much readier mode of preparing it is from the oxide itself. The lead promotes sedative action but is not essential to it.

We will now turn to the internai administration of silver. The use of the