A Handbook of Physical Diagnosis, Comprising the Throat, Thorax, and Abdomen

Reviews, 229 REVIEWS. A Handbook of Physical Diagnosis, comprising the Throat, Thorax, and Abdomen. -by 1)R. .FAUL Uuttmann, Jtferiin. Translated from the third German edition, by Alex. Napier, M.D., Glasgow. London: The New Sydenham Society. 1879. The experience of most of our readers will bear us out when we say that, as students, it was mostly with a certain sense of bewilderment that we followed the careful physical diagnosis of a painstaking teacher. Even when we got towards the end of our student career, and began to have the fear of a clinical examination before our eyes, the mysteries of percussion and auscultation were still to a great extent unsolved. It was much if, at this stage of our career, we had sufficient confidence in our own powers to be able to demarcate, with an ease satisfactory to ourselves, the normal cardiac or hepatic dulness. And when we entered on the duties of the practitioner, we had, for a time at least, to go through a somewhat severe pro- cess of observation and experimentation, before we acquired any confident belief in the connection of physical signs with pathological phenomena. In this period, during which we are acquiring a more or less valuable amount of personal aptitude, we are too apt to forget the directions of our teachers, and to " get into a way of our own," which may be better than no way, but is very likely to be inferior to the methods of those who have been carefully studying the subject under the most favourable conditions. When a conscientious general practitioner has become familiar with the more prominent features of the general run of cases, and has acquired some personal aptitude in the methods of physical diagnosis, it is of immense importance that he should for once review his position, and in the light of his acquired experience, as it were go back to the student's position. For this purpose a thoroughly trustworthy guide is necessary, and we believe that such a guide is furnished by the volume before us. We are persuaded that if the practitioner will carefully study this work, and conscientiously carry out its suggestions, he will find an incalculable advance in the realistic appreciation of diseases by means of their physical phenomena. The work is not properly a student's book. It presumes a certain familiarity with the diseases of the organs with which it deals, and the endeavour is made to connect the physical 230 - Reviews. phenomena with the pathological conditions present in these diseases. It was therefore a wise decision of the Committee of the Sydenham Society to place a translation of it in the hands of its Subscribers, comprising, we presume, the bulk of the more intelligent practitioners in the United Kingdom. We should recommend these to give it a careful perusal, and we believe that the effect will be the promotion of a more scientific attitude on the part of the practitioner towards the diseases he has to treat. In the remarks already made, the scope of the work is indi- cated. Its method is perfectly simple and direct. Under the various sections the different methods of exploring each organ are first discussed, and then the conditions likely to be met with are described. These states are not merely enumerated, but the mode in which they influence the physical conditions and so effect the results of physical examination, are fully entered into. The advantages of this method of treatment are apparent. In a book covering such a wide range of subjects it is impossible to give any sufficient idea of its scope, or any detailed criticism of its contents. As might be expected, all the sections are not of equal value, the appendix on Laryn- goscopy being perhaps the least satisfactory. There is one feature of the work which seems to us to enhance its value for the English practitioner, and that is, the close connection which is drawn between pathological anatomy and physical diagnosis. It will not be disputed that the exist- ing English practitioner has not as a rule received that careful training in pathological anatomy which is to be obtained in the German schools, and it will be readily acknowledged that medical practice in Germany is, at the present time, largely dominated by the school of pathological anatomy, founded by Virchow. This fact comes out very strongly in JNiemeyer's well known Text-book of Practice of Medicine, and the great estimation in which this book is held by many is largely due to this. The present work has a similar character, and it may even be said that, to a great extent, even the terminology is that of pathological anatomy. We believe that in this regard the book will be of peculiar value to the practitioner for the purpose referred to above. There is perhaps one criticism which might be made on the style of the work, and it is, that for one who would read it continuously there is an exceedingly rigid systematisation of the subject, and a certain want of that freedom of style which carries one on from page to page. At the same time, the nature of the subject hardly admits of a different style of treatment, Reviews. 231 and viewed as a book of reference, the quality referred to may be regarded as a distinct advantage. In regard to the manner in which the translation has been executed we have nothing but praise to accord; the German idioms have been carefully rendered into good English, and although the book as a whole distinctly preserves, as it ought to do, the main characteristics of a German medical work, yet this cannot be said of the literary construction. .

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