QUAIN'S DICTIONARY OF MEDICINE.*
Wrrn the euormous increase that each year brings to the mass of facts constituting human knowledge, a corresponding desire appears to be felt of reducing it to some sort of manageable bulk. Hence dictionaries and encyclopedias are the order of the day, and, meeting a real want, find a ready sale. In no department of human intellectual activity is the need more felt than in Medicine, to pause, as it were, from time to time, and resume, as concisely as may be, the actual condition or the art and science. Dr. Copland's monumental work has long been out of date, and was, besides, rather a collection of trea- tises than a dictionary, properly so called. The plan of the pre. sent book is different, and Dr. Q,uain's undertaking is a novelty in English medical literature. In the first place, the volume does not aim at furnishing the reader with more than a general view of each subject ; secondly, the editor has extended the term "medicine," so as not only to overlap considerably the borders of surgery,but to include much of what has been far too little studied by medical men, public and personal hygiene. Dr. Quoin has been fortunate in associating the best-known names in medical science with his own in the execution of hie difficult task. The signatures to the various articles are a guarantee of the adequate treatment of their respective subjects, and the volume has a weight and authority as the expression of the views of the pro- fession which render it a guide as safe as indispensable to the practitioner. We do not pretend to have done more than dip at intervals into the two thousand pages of which the book con- sists, but the articles we have read have struck us as models of clear and fluent scientific English. The contribution on Fever is • a conspicuous example, to cite one instance only, of scientific 41
lucidity" of language, thoroughly intelligible to the lay reader, yet not a whit below the needs of the specialist. To those who know something of the enormous bulk of even current medical literature, the comprehensive survey of the " mystery " afforded by this volume will appear a marvel of informed and patient in- dustry. The compression of matter has of necessity been great, but so judiciously has it been effected, that conciseness does not seem anywhere to have been purchased at the expense of -clearness and intelligibility.
One reflection that a cursory glance at the contents of the -volume is likely to give rise to, is that the Doctors of to-day owe no small reparation for the misfeasance of their predecessors. The " heroic " methods that more or less infested—we can use ito other term—medical and surgical practice up to a very recent period, were productive of extremely fatal results. Operations were performed with "brilliance," indeed, but with total contempt or neglect of the precautions as to cleanliness— scientific surgical cleanliness—of the instruments, the operator, and even of the surrounding atmosphere, that are now considered absolutely indispensable, with the result of an enormously diminished per-centage of fatal sequences. Pneumonia was treated by venesection, tartar emetic, So., and "as these methods have been abandoned," says Dr. Green, "the mortality has diminished." A propos of venesection, we notice with some surprise Sir James Paget's assertion that the customary * A Dictionary of Medicine, including General Pathology, Hygiene, .fia. By Various Writers. Edited by Richard Quain, MD,, P.n.s. London : Longmans, Areal, and Co. 1892. venesection, of former days was absolutely harmless. Surely, it involved more or less waste of the total nervous and vegetative energy of the system. Of diphtheria, again, up to quite recently, the treatment was positively barbarous. In 1868, the great French authority on the disease, Trousseau, insisted upon the necessity of applying strong caustics, to destroy the characteristic false membrane that forms in the throat. Only those who have witnessed the painful struggles of children submitted to this torture can appreciate the cruelty of the method. Now, Sena, writing in 1877; tells us that" cauterization is generally abandoned ; it has serious drawbacks, it is dangerous, it is use- less." Danger and uselessness do, indeed, seem somewhat serious drawbacks. The " heroic " method was the outcome of superficial observation and rash empiricism. It is not likely to be ever again in vogue, for the more scientific study of Nature in health and disease leads to an abandonment of all violent means and remedies. Humanity cannot be too thankful for the change, when it is–recollected to how great an extent we are all at the mercy of the profession, and how terribly, owing to lack of proper scientific training, and to the backward state of biological and pathological science, the practitioner of the past slashed, blistered, bled, and purged our foregoers, to their hurt very much more often than to their benefit.
The article on " Alcohol " will not please the teetotallers. In small quantities and diluted, according to the author of the article, Dr. Binz, of Bonn, it is readily assimilated, undergoes combustion, imparts warmth, and yields vital force to the tissues for the performance of their various functions :—" A quantity of 100 cubic centimetres per diem (about 3i fluid ounces), equivalent to one litre of Rhine wine of medium strength, is sufficient to supply between one-third and one- quarter the whole amount of warmth requisite for the human body during the twenty-four hours." The alcohol, how- ever, must be pure,—that is, free from fusel-oil elements ; members of the propyl, amyl, and butyl series. On the other hand, in the article on "Personal Health," total abstinence from alcoholic drinks is recommended ; but in the same article, curiously enough, beer and claret in moderate amount are said to be beneficial to youth between puberty and manhood.
The pathology of inflammation is extremely well treated under that heading, and the extraordinary " migration " of the white blood-corpuscles, by a Bort of self-extrusion through the walls of the smaller vessels, chiefly veins, which characterise the process, is admirably described. All the articles, indeed, of a general nature will be found most interesting by the lay reader, who will rarely be troubled by excess of tech- nical language or want of clearness in exposition. Of the vast and important subject of contagion, for instance, every one is concerned to know something ; and the study, apart from its special interest to humanity, is of the highest value, in assisting us to form a conception of the modes in which the tremendous interval between inanimate and animate existence may be bridged over.
There is evidence that some of the articles have not been worked up to the level of the most recent knowledge. Thus, the disease known as " ben-ben i " is quite insufficiently described, and its identity with " kakke," an endemic disorder in Japan, of which an exhaustive study, by Mr. Anderson, formerly Surgeon to the British Legation at Tokio, will be found in the Reports of St. Thomas's Hospital for 1876, is not mentioned. In a work of this kind, however, it is, perhaps, im- possible that the most recent science should be worked into every contribution, for this would involve a universal know- ledge on the part of the editor to whom the task of revision falls.
In addition to articles on purely medical subjects, or what were commonly supposed to be alone entitled to rank as such, the volume contains, as we have already hinted, many on matters of general interest to the public at large, though not the less important on that account to the practi- %loner. Thus such subjects as baths, idiosyneracy, civil incapa- city, nursing, diet, cold, climate, personal health, &c., are treated in a manner as interesting as instructive. In the article on diet, a happy mean is hit between vegetarianism and the opposite "ism," if the word exists—if not, we may suggest "
vorism "—in the maxim that those who lead sedentary lives should eat less meat and more vegetables than those who pass a life of active labour in the open air. As a rule, the practice of mankind is the exact reverse, owing to the luxurious habits of the wealthier sedentary classes, and the poverty of the outdoor bitter twang of his own tongue too well, and he had remained a lead- ing lawyer in Equity, when he might have ended a Judge, or even a Congressman. Of late years, however, since people whom he could have joined in their Agnosticism so heartily, up to a certain point, had begun to make such fools of themselves about Darwinism and the brother of all men in the monkey, he had grown much more tolerant ; ho still clung to his old-fashioned, deistical opinions, but he thought no worse of a man for .not holding them ; he did not deny that a man might be a good Christian, and still be a very good man. The audacious humour of his position sufficed, with a people who liked a joke rather better than anything else. In his old age his infidelity was something that would hardly have been changed, if possible, by a popular vote." .
How Marcia's engagement was broken off, and how she and Bartley came together again, we will not tell here; suffice it to say that they were married, and went to Boston to make their way. Bartley was not afraid of hard work, he had a ready pen and plenty of wit, and after some up-hill work he gets employed on different papers, writing chiefly on social subjects, which he has a happy knack of making telling and attractive. Nothing can be more charming than the account of their early married life; their search for cheap lodgings and inexpensive dinners. In time he gets plenty of work and pay, but Marcia feels it is precarious, and her own ambition is that he should get a" basis," permanent work with a fixed salary, The account of how he gets it, with a Mr. Witherby, proprietor and chief editor of a journal which had a large circulation in Boston, is curious, as showing the way that an unoonscientious but still respectable paper in America is managed. Witherby had quarrelled with hi a sub-editor, who had. "views" of his own about the working of a journal, which views did not agree with those of Mr. Witherby. This gentleman is of opinion that a paper is no good till it pays ; it has no influence, its motives are suspected, and it cannot forward any good cause. He did not contend that a paper should run solely in the interest of the " counting-room," but-he did think that the counting-room should be respectfully listened to in the editorial room :— "'There are always two sides to every question. Suppose all the newspapers pitch in—as they sometimes do—and denounce a certain public enterprise, a projected scheme of railroad legislation, or a peculiar system of banking, or a co-operative mining interest, and the oounting room sends up word that the company advertises heavily with us, shall we go and join indiscriminately in that hue and cry, or shall we give our friends the benefit of the doubt ?'—`Give them the benefit of the doubt,' answered Bartley.—' That's what I say, and so would any other practical man,' said Witherby ; and that's just where Clayton and I differed.'"
Terms were come to, and the salary fixed, which surpassed Bartley's highest expectations ; and his chief delight in it was the satisfaction that it would be to Marcia. He gave her a full history of the affair, and they were as happy as if Bartley had been celebrating a high and honourable good-fortune. She was too ignorant to feel the disgrace, if there were any, in the com- pact which Bartley had closed,—and he had no principles, no traditions, by which to perceive it ; to them, it meant unlimited prosperity, it meant provision for the future, which was to bring a new responsibility and a new care. The sphere of Boston life to which we are introduced is graphically described, whether it is the newspaper world, the semi-fashionable world, or that to which the family of Bartley's college friend Hallett belonged, the wealthy, sectarian, and old-fashioned world. " Society " in Boston is Unitarian, just as in New York the fashionable religion is an Americanised Church of England, and it is very curious that it seems to be necessary for social success to belong to the fashionable religion. The Halletts were not Unitarians, and the son had been sent to an inferior sectarian college, instead of to Harvard, where, as a matter of course, the best Boston men were to be found. Young Hallett is a curious study. Contrary to Ameri- can ways, he had not been allowed to decide on his own career; and he felt that his life had been sacrificed; but with his sensitive, dreamy, idealising nature he would probably have felt out of harmony even. among Harvard men and the best Boston society, though he did not think so himself. We fancy, however, that there is meant to be a touch of sarcasm in his self-judgment. His character is scarcely that which one expects often to meet with in the American go-a-head world, but it is delicately and consistently worked out. The whole Hallett family is good ; the charming old couple, so generous and high-minded, the two elder sisters, narrow-minded and given to good works, the younger sister, born since her parents had become wealthy, determined to be liberal- mulued, and steer clear of what she considers the family failings, are all very happily portrayed ; one really lives among them, gets to know them personally, and feel their individuality. Not so the rich and fashionable Miss Kingsbury, with her generous
impulses, and a certain amount of unrecognised social snobbism. She is more of a lay figure. Mr. Howells' remarks on what he says that we English think of as our superior civilisation, are original and very entertaining, and, both the English accent and the English manners meet with, perhaps to us, un- expected criticism. He does not touch much, however, on English ways ; the chief interest of his book is certainly duo to the strong flavour of Americanism which pervades it, What interests us throughout is the vivid picture of American social life as it really is.
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