ture, progress, and extent of diseases of the chest has engrossed the attention of a great many physicians, both in hospital and private practice. It was not to be expected that a method of diagnosis, so new and dependent often for its accuracy upon circumstances peculiar to individual observers, was to be all at once, or by one person, carried to complete perfection. The explanations accordingly given by Laennec of several of his signs, and of their indications, have not been received by all subsequent observers with the same degree of unanimity; and several auscultators have not only doubted the accuracy of several of the stethoscopic signs specified by him, but they have themselves given new explanations of some of the sounds afforded by the lungs and heart, and, in other instances, they have modified several of the signs mentioned by Laennec.

These circumstances,-the natural progress of science and the wish to diffuse the knowledge of a very important branch of diagnosis, have given rise to the publication of a great number of works devoted either to auscultation and percussion, and the best methods of studying them, or to the history of the diseases of the lungs and heart, and their diagnosis by means of auscultation and percussion. Hence, in addition to a considerable number of manuals and guides on the subject, we have had not only four editions of the work of Laennec, with four editions of the translation, but works of different degrees of merit from Dr Forbes, Dr Williams, the late Dr Davies, Dr Latham, Dr Hope, and Dr Stokes in this country; and abroad by Andral, Piorry, Louis, Chomel, and Bouillaud; besides numerous essays and observations in different journals by many authors.

Of all the works, however, which have been published on this subject since the time of Laennec, no one is more remarkable for the originality of the views of the author, for the amount of accurate and precise information, and for the numerous and extensive rectifications made by him, than the work of Dr Skoda of Vienna. Dr Skoda has the merit of being almost a self-taught observer, so far as auscultation goes. Trained in the usual career of medical education, his attention was not directed to any particular department of medicine, nor had he the benefit of either example or instruction in the use of the stethoscope. Auscultation, indeed, was not only underrated in the clinical department of the hospital before his time, but it was even despised, and consequently unknown. Dr Skoda had full access to the great general hospital, had ample means of studying the symptoms of diseases of the heart and lungs by means of auscultation, and he did so rather by observing for himself than by adopting the distinctions laid down by his predecessors and contemporaries. The result of this is, that his observations are remarkable for their originality; and, as he has been less fettered by the systems of his VOL. LVI. NO. 148.

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predecessors and contemporaries, he has succeeded in giving of the phenomena of auscultation and percussion views not less remarkable for their novelty than accuracy.

In consequence of being obliged to study the phenomena and indications of auscultation and percussion in the manner now mentioned, when Dr Skoda came to compare the results obtained and the conclusions drawn by himself, with those given by other authors, he found not only great discordance, but difficulty amounting to impossibility of assenting to many of the views given by other authors. He was led consequently to revise, and rectify, and compare his views more accurately; and especially in the course of giving clinical instructions, to explain these views more at large, and adduce the facts on which they rested. In this manner he found it necessary to embody the whole of his views in a separate treatise; and of this labour the present volume is the result.

The volume consists of two general divisions. The first is devoted to the description and explanation of the phenomena which are observed by means of percussion and auscultation. In the second division, the author takes a view of the particular morbid conditions of the organs of the chest and abdomen, and the phenomena furnished by them, which are ascertained by percussion and auscultation.

The first part is subdivided into two sections; one on the subject of percussion, and the other on that of auscultation.

The first section consists of two chapters; one on the sounds elicited by percussion, and their varieties and their conditions; the full and empty sound; the clear and dull sound; the tympanitic and the untympanitic sound; the high and the deep sound; the metallic ringing sound; the moist or humoral sound of Piorry; the sound of the cracked pot, and the hydatid tone of Piorry.

In a second chapter he devotes some observations to the examination of sensible impediments to percussion.

The second section on auscultation is much more extensive; and the author here enters into an elaborate view of the various phenomena and symptoms afforded by auscultation, and the best mode of observing them. The section consists of two chapters; the first devoted to the auscultatory phenomena furnished by the organs of respiration; the second to those furnished by the organs of circulation.

Of a considerable portion of this division of the work an abstract has been given in another part of the present Number, (p. 88); and another abstract shall be given in our next, so that it is unnecessary here to enter into any detail. It is enough to say, that Dr Skoda considers very minutely and carefully the varieties of sounds furnished by the voice transmitted through the chest in the healthy condition and the different states of disease.

The second part is also divided into two sections; the first devoted to the normal or healthy state of the thoracic and abdominal organs, and the phenomena which in this state they furnish upon percussion and auscultation; and the second to the abnormal or unhealthy state of these organs, and the phenomena which in that state they furnish upon percussion and auscultation.

After first distinguishing the latter into three general heads, viz. unnatural positions of the thoracic and abdominal organs, irregularities in the structure of the bony part of the chest, and morbid conditions in the organs of the chest and belly, he directs the great force of his attention to the examination of the latter subject, which is ample, elaborate, and satisfactory.

The auscultatory and percussion symptoms of the different diseases of the lungs he enumerates and describes in the following order: 1. Diseases of the bronchia; 2. Diseases of the pulmonic parenchyma, viz. pneumonia, gangrene, pulmonary apoplexy, œdema of the lungs, emphysema, hypertrophy, atrophy, and tubercles, in different forms and stages; 3. Diseases of the pleura, viz. pleurisy, hydrothorax, pneumothorax, tubercles, encephaloma, &c. The auscultatory and percussion symptoms of the heart are enumerated and described under the heads of morbid states of the pericardium, morbid states of the substance of the heart, morbid states of the endocardium, and morbid states of the aorta and pulmonary artery.

In the present short notice, we have already virtually expressed the opinion, that the treatise of Dr Skoda is entitled to the first rank among those devoted to the subject of auscultation and percussion. We adverted in previous numbers to the merits and characters of most of the treatises on this subject at the time of their appearance; and only in our last number we had occasion to introduce to our readers a very excellent manual by Messrs Barth and Roger. We should have previously, perhaps, spoken of the small but useful Manual of Dr M. A. Raciborski, a performance in which the author showed much knowledge of the labours of his predecessors and contemporaries, and intimate acquaintance with the most arduous and obscure, and controverted points of the subject.* It must not be ascribed to any desire to depreciate the services of these meritorious labourers, if we still assign the palm of superior merit to the Treatise of Dr Skoda. All these treatises and manuals are excellent in their way; all have been serviceable, and will continue to be serviceable, in communicating and diffusing the knowledge of the art of observing by means of auscultation and percussion the phenomena of diseases. The present work, however, possesses peculiar merit in containing, not only more original views than most others on the same subject, and in rendering the information precise and accurate, but also in a more thorough

* New and Complete Manual of Auscultation and Percussion, applied to the diagnosis of Diseases. By M. A. Raciborski, M. D., &c. Translated by William Fitz. herbert, B. A. Cambridge. London, 1835.

application of the laws of physics and acoustics, and consequently a greater degree of scientific consistence than is observed in other treatises.

It is desirable that a work possessing so many recommendations should no longer be confined to the original. A good English translation, we have every reason to believe, would be well received and very generally studied.

ART. V.-The Anatomy of the Arteries of the Human Body, with its applications to Pathology and Operative Surgery. In Lithographic Drawings, with Practical Commentaries. By RICHARD QUAIN, Professor of Anatomy in University College, and Surgeon to University College Hospital. The Delineations by JOSEPH MACLISE, Esq. Surgeon. Part I, II, III, IV, 1840; V, VI, and VII, 1841. rial Folio.

London.

Impe

THE correct anatomical knowledge of the origin, position, course, and distribution of the arteries of the human body is a matter of such indispensable necessity, and the necessity of this knowledge is of such daily recurrence, that it is impossible to render the study of that branch of anatomy too minute, or to diffuse a taste for it too widely. Every surgeon feels in the course of the daily exercise of his profession, that difficulties take place which often make him admit, either that his knowledge is deficient, in not embracing all the possible deviations which may occur, or in not distinguishing between that which is constant and that which is only general, and sometimes in ascertaining what is regular and what is irregular. This is particularly true of what is termed the Surgical Anatomy of the Arterial System,-a branch of knowledge which has been created only during the last thirty years; and which is daily acquiring a higher degree of interest and importance, in proportion as the question, not only of the practicability of operations involving the arteries is concerned, but also that relating to the most eligible and expedient points for the application of ligatures comes under consideration.

Haller, that name which is consecrated by the remembrance of so many services to anatomy and physiology, was the first who, in his Icones Anatomicæ, gave good delineations of the origin, course, and distribution of the arteries; and for more than eighty years his work continued the great authority in every point relative to the anatomical history of this system. This work, however, labours under two deficiencies, which are acquiring greater magnitude as the necessity of the knowledge of the surgical anatomy of the arteries becomes more obvious and urgent. First, most of the views of Haller were given from the blood-vessels and bodies of young subjects; and secondly, too little regard is paid to the relative points in the course of arteries; and, in short, to

those facts which are necessary to the knowledge of their surgical anatomy. Scarpa, indeed, attempted to supply many of these defects and omissions, and did it very ably; and the late Sir Astley Cooper contributed most essentially by his labours to supply others.

A complete and systematic view, however, of the anatomical relations of the arterial system was still wanting when the large and valuable work of Tiedemann appeared in 1822. The numerous views of varieties in origin, course, and distribution, presented by that work, threw new light on the subject, and, by showing how much accurate information had been required, invested it with greater interest, and inspired others with the desire of studying it more extensively and more accurately. The work of Tiedemann is, indeed, in no respect so useful as in showing that, without more extended observation and more careful study, it would be quite impossible to say when all the varieties in the arterial system might be allowed to be fully ascertained and perfectly made known.

The present publication affords clear evidence of the justice of these views. The author has been for several years engaged, in the course of superintending a large anatomical establishment in London, in observing all the varieties presented by the trunks and large branches of the arterial system; and as his observations, in a field so extensive, gradually accumulated, he was at length in a condition to draw conclusions both as to those facts which might be regarded from their number as constant, and consequently might be deemed capable of establishing some standard as to origin, course, size, and distribution, and also as to that less multiplied class of cases which might be viewed as deviations from the standard, exceptions to the rule, irregularities, and anomalies, and in some measure to estimate the comparative frequency or rarity of each order.

The present work is therefore manifestly the result of great labour and care. The seven numbers before us contain about the half of the proposed work, that is 35 plates among 65; and in these 65 plates will be given views of all the most usual conditions of each of the large arteries in the human body as they were observed in about 290 subjects.

The work is also accompanied with descriptive letter-press in 8vo. In these explanatory pages the author not only describes the usual origin, course, and relations of the large arterial trunks and branches, but he gives tabular views of the measurements made to determine the exact point of origin in a considerable number of cases, with a view to surgical operation, and also a number of practical inferences on the most proper parts for performing operations or applying ligatures.

The seven numbers already published embrace the arch of the aorta and the branches which issue from it, with all the variations,