No. 4. Inhabitant of nine years; suffering from tonsillitis; had undergone long courses of endemic fevers; spleen engorged but indolent.

The remarks on treatment are sound, but do not add to our previous knowledge. Some experiments, however, were made to determine the relative value of the different salts of quinine, and of various other substances. We regret that the number of these was not more limited, as those employed would then have been tried upon a greater number of patients, and the results consequently much more worthy of confidence. Twelve preparations of quinine were employed, and on the whole the sulphate found most beneficial, but when given as usual dissolved in water with excess of sulphuric acid, gastric and cephalic symptoms were very common, and often rendered a discontinuance of the medicine necessary. This was obviated by manufacturing a crystallized neutral sulphate of quinine, which is soluble in eleven times its volume of distilled water. This hint is worth the notice of our pharmacologists.

Of the other substances experimented upon, although none have shown an antiperiodic action equal to that of quinine, still the camomile, the extract of fillirea, (Fillirea latifolia) fillirina and its sulphate, the extract of olive, and a substance called olivina, the bitter principle of the olive leaves, are worthy of considerable attention. The results of their exhibition were very satisfactory in many bad cases during the worst part of the season. On economical grounds alone, a trial of these remedies in periodic diseases should be made in our hospitals. Olive leaves, and the fillirea might be readily procured at a very trifling expense, and perhaps render us great assistance in case of any deficiency in the supply of cinchona. The powdered camomile flowers succeeded well, but it was difficult to give a sufficiently large dose. Might not the active principle be prepared for the market?

Salicine and arsenious acid were both employed without good effect. The fillirea and fillirina were used in seventy-two cases. The camomile

powder in twenty. Salicine in four. Arsenic in sixteen. Olivina and the extract of olive in fourteen. Preparation of quinine in seventy-seven.

We have thus gone through the valuable work of M. Salvagnoli, and have condensed into this article such of its contents as we believed likely to be useful or interesting to English practitioners. The style is clear and simple, the reasoning generally sound, and our only regret is, that the statistical information was not presented in a more condensed form, and for a longer period, and that M. Salvagnoli had not devoted a chapter to the means of remedying the evils he has so well described.

II. The second book on our list is one of those minute and laborious works in which a German author delights, but which an English reviewer approaches with a feeling akin to despair. The multiplicity of subjects of which it treats, and the very slender tie by which they are held together, render a connected account of it next to impossible. All that he can hope to do, is to select a chapter here and there, and cull from it such facts as promise the largest share of amusement and instruction. This is our aim in the present short notice; we shall, therefore, clear at a leap the first fifty pages, with the commendatory preface of Dr. Casper, and alight on the chapter treating of the population of Berlin.

In the interval from 1590 to 1841, the population of the city increased from 12,000 to 321,505. This increase was far from regular, for in the year 1661 the number of inhabitants fell as low as 6500. The population for the year 1841 presents a remarkable approach to equality between the number of male and female inhabitants, the former being 160,802, and the latter 160,703. To the males, however, will have to be added the military, to the number of 11,744. This approach to equality in the number of male and female inhabitants is only observed in the one year 1841, the females exceeding the males in all the preceding years, with the exception of 1840, when the males were slightly in excess. The 321,505 inhabitants, male and female, were thus distributed according to age. Up to the end of the fifth year, 38,815; from the end of the fifth to the end of the seventh years, 12,286; seven to fourteen, 38,162; fourteen to sixteen, 10,803; sixteen to forty-five, 183,904; forty-five to sixty, 31,673; sixty and upwards, 15,862. The males exceed the females up to forty-five years of age, but fall considerably short of them after that period.

From 1820 to 1840 the civil inhabitants of the city increased by 105,756, of which increase, 24,626 was the excess of births over deaths, and 81,130 the excess of immigrants over emigrants.

The number of married persons in Berlin, in the year 1841, was 42,752 males and 42,864 females, the excess of females being accounted for by the circumstance of several of the husbands being engaged in travelling or being in prison beyond the limits of the city. The number of births for the same year was 10,757, which gives rather less than one birth annually to four married couples. The average number of children to a marriage was 3, or, after some necessary correction, 3.

The proportion of births to the total population, on an average of years, is 1 to 27, and, for the year 1841, 1 to 30-31. The male births were to the female as 1 to 1, in other words, out of 37 new-born infants, 19 were males, and 18 females. There was one marriage to 100 inhabitants.

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Twin births formed T of the total births, and there was one triplet in 6279 births.

Such are the principal contents of the chapter on population, from which, passing over some eighty pages treating of matters of no medical interest, we turn to the chapter on the morality of Berlin, which opens with a passage, in justification of our choice, setting forth the intimate relation which exists between morality and health. The first point to which our attention is drawn, is the proportion of illegitimate births. It appears that, on an average of seven years, there was one illegitimate birth to 6 legitimate, or 14 per cent. Among the Roman Catholic inhabitants, we are told, the proportion is not much better, but among the Jews it is nearly six times better than the general average. This proportion of 1 to 9 contrasts favorably with several of the large continental cities. In Jena it is 1 to 7; in Stockholm, Dessau, and Göttingen, 1 to 6; in Dresden and Leipzig, 1 to 5; and in Paris, 1 to 34. St. Petersburg presents the very favorable proportion of 1 to 20. The statistics of suicide present some points of interest. In the interval from 1788 to 1797, only six suicides a year occurred in the city of Berlin; from 1799 to 1808, twelve a year; but from 1813 to 1822, as many as fifty-four. This increase is out of all proportion to the increase of population, for during the first period, the proportion which suicides bore to the population was 1 to 26,000; during the second period 1 to 13,000; and during the last period, 1 to 3000. The proportion of female to male suicides at these three periods respectively, was 1 to 8, 1 to 3, and 1 to 5. The crime was most frequent between the ages of 40 and 50, least so between 70 and 80; but one case is recorded under 10 years, and two above 80. The most common causes were insanity and drunkenness; fear of punishment and want ranked next; and religious enthusiasm was the least common cause. The greater number of the criminals belonged to the class of artizans. The favorite mode of death in Berlin was by hanging; next to this by the pistol. In Paris, where suicide, like everything else, must be done with eclat, the pistol or a leap from a window is preferred. To the acknowledged suicides must be added a certain proportion of 70 bodies found in the water in the course of two years. The season of the year does not appear to have exercised the same influence on the frequency of suicide as it has been shown to have done at Paris.

The number of suicides at Berlin, when compared with that occurring in several large cities, is considerable. During the last-named period (1813 to 1822) it was, as we have seen, 1 in 3000. In Naples it was 1 in 27,230; in London, 1 in 21,491; in Milan, 1 in 18,021; in New York, 1 in 9474; in Hamburgh, 1 in 4500; in Leipzig, I in 3143; in Paris, I in 2215; and in St. Petersburg, 1 in 416 (?) This chapter on the morality of Berlin concludes with the somewhat startling statement, that a separation takes place for every 200 or 300 marriages, a fact which points either to a low state of morals or to unusual facility of divorce.

We now pass on to the chapter on the mortality and duration of life in Berlin. In the interval from 1819 to 1841 there died on an average 1 in 36 of the inhabitants. The numbers dying, at different ages, were as follows. Out of 1000 living of both sexes, the deaths during the first year amounted to 282 males and 266 females; under 10 years the

numbers were 465 males, and 473 females; under 20, 492 males and 502 females; under 30, 578 males and 565 females; under 40, 650 males and 633 females; under 50, 734 males and 706 females; under 60, 822 males and 783 females; under 70, 907 males and 870 females; under 80, 971 males and 957 females; under 90, 999 males and 995 females; and under 97, 1000 of both sexes. The living for the same periods are easily ascertained by a simple process of subtraction. Still-births were in the proportion of of the total mortality.

Several tables of considerable interest to the statistician will be found from page 353 to page 386, but our limits will not allow us to do more than refer to them for information.

We have noticed only a few of the contents of this very laboriously compiled volume. Those who wish for very minute and trustworthy information on almost any imaginable subject which can be comprised under the two heads of medical topography and statistics, are referred to Dr. H. Wollheim's work, where they will most probably find what they are in search of.

ART. XIX.

The Nature and Treatment of Gout. By WILLIAM HENRY ROBERTSON, M.D. Physician to the Buxton Bath Charity. London, 1845. 8vo, pp. 372.

Ir seems to us, that in writing this treatise Dr. Robertson has had it in view to make a book, and with this we do not altogether find fault. Mean motives (we use not the word in an offensive sense) have produced excellent ends; an interest the most personal has often swayed a man to an enterprise, a course of action, which, as regards others, has all the effects which philanthropy itself would desire to accomplish. The wish that Dr. Robertson as Physician to the Buxton Bath Charity, may feel to render his name noted in association with the successful treatment of gout, is at once natural and laudable; and to this, as already stated, we have nothing to object. We could have wished, however, that the author, in attaining his end, had inflicted on the public a less plethoric volume than he has done. Why! if gout consists in redundant, unassimilated, unreduced humours, then is Dr. Robertson's volume congenitally gouty. It is tumid with undigested extraneous matters, and if it should be born again (we mean in the way of a second edition) we should recommend that the author, before his second literary accouchement, should, by something of the nature of intellectual phlebotomy, practised on himself, lessen the chance of his again giving birth to a production, the component parts of which, even were they all sound, must at least be owned to be monstrously developed.

We do not say that Dr. Robertson's book is a stupid one, or without some useful matters; what we assert is, that in proportion to such useful matters, its bulk is unnecessarily great, and that too much of the work is occupied with diffuse, desultory observations.

The treatise is divided into eight chapters, the first of which is introductory, and the succeeding ones are devoted to a consideration of the causes, nature, history, and treatment of gout; "the treatment and mr

nagement of the gouty habit of body," (chapter 7,) and the means of preventing the gout.

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The first or introductory chapter presents nothing of novelty or interest. In the second chapter, or that in which the remote causes and predisposing cause are considered, we have a simple recapitulation of what is to be met with in every treatise on the subject of gout. Hereditary influence" is stated to be the "principal remote cause." Sedentary habits, undue exercise of mind, intemperance in food, &c., are successively and prolixly discussed. The exciting causes are more summarily noticed. These are stated to be sudden changes of temperature, "an immoderately large and heavy meal," an excessive use of wine, &c. The nature of gout is next considered. It is stated to consist (p. 69.) "in the deposition of lithic (uric) acid and its compounds, with alkalies, and principally with soda, in the fibrous tissues."

The lithic acid diathesis, according to the author, presents itself under two forms, or rather has two modes of manifesting itself. In the one, the acid and its compounds escape in the urine; in the other, they are deposited in the tissues above named. The author accordingly seems to consider gout, or the gouty diathesis, essentially to consist in a morbid tendency to the deposition of uric acid or its combinations, and in a "much disordered condition of the tissue in which it is formed." (p. 72.) Dr. Robertson thinks it not improbable that the acid, though, as constituting gouty concretions, or chalk-stones, always found in a combined state, is originally deposited pure, and gradually afterwards takes soda from the blood. This," he observes, p. 73, "would serve to explain the immediate deposition of lithic acid, where it is formed, and likwise that other alkalies besides soda are often found combined with it, although in comparatively small proportions, soda being the principal alkali of the system." He elsewhere re-states this view, (p. 78,) and expresses it as his opinion that the irritation of the capillaries of the fibrous tissues, caused by "the throwing down of crystalline particles of lithic acid, "or of its compounds with alkali," may be the true cause of gouty inflammation.

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This deposition of lithic acid has been by some ascribed to "defective oxygenation of the organic atoms which have served their purpose in the economy," and which require an additional proportion of oxygen in order to form them into a soluble product capable of being eliminated as urea. The author, with some plausibility, argues, that if this view were true, gout should be most found where food containing much carbon was used, and least where such diet was least employed; but we know the contrary of this to be the case.

The chapter, on the history of gout, contains a review both of the symptoms of an arthritic attack, and also of the derangements of other organs, which accompany it. The liver is usually much disordered in its action, and the kidneys equally or more so. We are, however, glad to hear Dr. Robertson bearing witness to a fact we have ourselves sometimes observed, namely, the presence of gout without derangement of the renal secretion. There has been an endeavour of late to exalt the indications afforded by the urine, even beyond their rank, high as that may be allowed to be, and to exaggerate the frequency with which these indications may be detected. "In some of the worst cases of gout," says Dr. Robertson,