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PREFACE.

In the ASCLEPIAD it is my intention to bring out in occasional volumes, after the manner of the volume now presented, a series of essays on subjects relating to medical science in its various departments. I cannot promise in this series any distinct regularity of publication, inasmuch as time, labour, and thought are not altogether at my disposal; but I hope that the volumes will, on an average, be issued half-yearly, or, at least, annually.

While it will be my object in this series always to consult, as far as in me lies, the requirements of practical medicine, I shall endeavour to weave into the subjects discussed such matters bearing on the current theories of medicine as shall tend to open the way to new and more comprehensive views, and to a sounder and more rational practice.

I wish it to be understood that if, in progress of time, any expression or opinion which may be advanced should prove on reasonable evidence to be incorrect, I shall not fail to make the correction. Nor shall I fear the charge that one volume is not strictly in accord with its predecessor; for, as Emerson aptly remarks, “ unyielding consistency is the hobgoblin of weak minds;" and, as in medicine many things are still very obscure, and all things admit of being re-learned and re-taught by the light of advancing knowledge, so it is not for the student to dogmatise and to refuse to re-construct because he has previously constructed.

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CONTENT S.

ESSAY I.

SUBCLAVIAN MURMUR.

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Introductory Note
Observed Facts and Analyses
Illustrative case
Murmur observed in 51 cases out of 2000
Preponderance in males
Diseases in which the murmur was heard
Cases of bronchitis
Cases of phthisis
Case of mixed bronchial disease and phthisis
Cases of anæmia
Cases of dyspepsia
Cases of disease of the heart
Absence of aneurism in cases observed
Tabular Arrangement of 51 Cases presenting Subclavian Murmur
Laws regulating occurrence of subclavian murmur
Absence of subclavian murmur in children
Subclavian murmur rare in females
Relative frequency in certain diseases
Murmur observed mostly in connexion with manual labour re-

quiring exercise of arms
Cause and Causation of Subclavian Murmur
Its origin arterial
Dr. Thorburn's theory-respiratory sound modified by the heart

and large vessels
Subclavian murmur an arterial sound modified by respiration
Proofs in support of this theory
Cause of vibration external to artery
Explanation given by Drs. Kirkes and Sibson

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Modes by which pressure is exerted on the artery

Pressure produced by diseased lung .

Murmur presented without disease in lungs
Murmur modified by position of arm
Methods educing sound analogous in action, but different in

prognosis.

Does a condition of the blood produce murmur ?

Exact Character of Subclavian Murmur

Three typical forms

Diagnosis of Subclavian Murmur, Differential and Absolute

Murmur may be confounded with four physical signs of disease

Diagnosis from aneurism of the arch of the aorta, of the innominate

artery, or of the subclavian

Diagnosis from cardiac murmur

Diagnosis from pleural friction-sound

Diagnosis from bronchial coo

Absolute diagnosis of subclavian murmur

Relationship of Subclavian to common Ancemic Murmur
Subclavian murmur may coexist with anæmia and be intensified by

it, but is independent.
Generally unaccompanied by murmur in other parts of arterial

system
Bearings of Subclavian Murmur on Practice
Value greater in diagnosis than in treatment
Diagnostic of bronchial disease
Subclavian murmur one of the earliest indications of tubercle
Caution in application to diagnosis and prognosis

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