arduous undertaking, paid a second visit to South America, reaching Guayaquil in Sept., 1861. He proceeded to Loxa, and in spite of the decree before mentioned, and now in full force, he managed to collect and despatch to India one hundred thousand seeds of C. officinalis.

Several sites have been proposed in various parts of India, as fitting for the culture of the cinchonas. Of these, the neighbourhood of Ootacamund, in the Neilgherry Hills, seems the most to resemble in elevation and climate the Peruvian habitat of the trees. The Ootacamund Gardens are, moreover, under the charge of Mr. M'Ivor, whose practical knowledge of his profession, and of the requirements of the cinchonas in particular, render him peculiarly fitted to superintend the experiment of the introduction and cultivation of these trees in India. Ootacamund may therefore be considered as at present the headquarters of the cinchonas in India; and to show what success has, up to this time, attended the experiment, we may mention that up to January, 1863, thirty-five thousand plants of the best kind were permanently placed out, while no less than one hundred and seventeen thousand seven hundred were in preparation, under Mr. M'Ivor's care. This gentleman's method of culture is described in an interesting report, dated July, 1862, and printed in the second part of Dr. Seemann's recently established Journal of Botany.' The Dutch experimenters in Java appear to have copied nature too slavishly, and to have grown the plants under the dense shade of the forest, where, in the consequent struggle for existence," the weakest succumbs. Mr. M'Ivor follows the "selective" principle, and gives his plants all the assistance and protection that theory and practice can afford. At present there are two principal plantations-one for the Loxa barks, which require a lofty situation, and another, at a lower elevation, for the red bark and calisaya-trees. Seven hundred and forty-five acres of land are in preparation for this experiment, and it is the intention of Government to plant 150 acres annually for at least ten years.

In Ceylon, too, Mr. Thwaites, a distinguished botanist, reports that he has raised nearly a thousand plants of C. officinalis from seed, and that numerous plants of the equally valuable species C. succirubra, are doing well.

In the neighbourhood of Darjeeling, in the Sikkim Himalaya, the cultivation is being carried on with energy, the plants having been derived from the nursery at Ootacamund, the Botanic Garden at Calcutta, and from Java. It is worth notice, that the plants from the latter locality, though exposed to more casualties on their journey, have proved to be far healthier than the others, and the loss among them has been, according to Dr. Anderson, the Superintendent of the Calcutta Garden, much less. Plantations have also been established in the north-western provinces, in Travancore in the Punjaub, in Assam, and other parts of India.

Our West Indian Colonies, although they have been supplied with seeds and plants, do not appear to have taken the matter up with the spirit and energy of the Indian Government. In Jamaica and Trinidad, however, the culture has been begun.

At Kew a depôt is maintained of seedlings and young plants, so that the prospects of the experiments, carried out in the face of so many difficulties, may be described as most favourable, the more so as the chemists assure us of the presence of the alkaloïds in the plants grown in Java and India. Dr. de Vry, in the report drawn up by himself and Mr. Junghuhn, enters into details on this subject; and Dr. Anderson gives strong presumptive evidence of the presence of the alkaloids in the leaves even of C. succirubra, grown in India. A strong infusion of the leaves was administered to some patients suffering from intermittent fever, and with apparently excellent effect. Should this observation be confirmed, the leaves would serve as a substitute for the bark, till the trees arrive of a size to allow them to yield a supply of bark.

Mr. Howard forcibly urges upon the profession the desirability of employing the salts of cinchonine as a substitute for quinine, as the same amount of febrifugal power may be obtained from the former as from the latter, and at one-fourth of the cost. It is assuredly of great importance that the accuracy of this statement be tested in practice.

Time, patience, and Government aid are needed for the success of the experiment now being carried on in India; Government aid, because few, if any, private individuals could or would undertake the necessary sacrifice of time and money.* Ten years must at least intervene before the trees can yield any profitable return on the outlay expended on them, unless, indeed, the leaves can be utilized. Is it not possible that by the time our Indian possessions are enabled to supply themselves and us with quinine, chemists may have discovered the means of producing this and the allied alkaloïds artificially, or may have supplied us with an efficient substitute? Meanwhile, we think that all concerned in the laborious undertaking whose progress we have attempted to record, have fair grounds for exultation in the practical results of their labours; nor must we overlook the immense services rendered by a member of our own profession, in the safe transmission of so many young plants from South America to England, and thence again to the hot regions of the Red Sea and India. Without the Wardian case such success would have been unattainable.

REVIEW II.

On Diseases of the Chest, including Diseases of the Heart and Great Vessels; their Pathology, Physical Diagnosis, Symptoms, and Treatment. By HENRY WILLIAM FULLER, M.D. Cantab., &c. &c.— London, 1862. Svo, pp. 703.

In this treatise, the extent of which is indicated by its comprehensive title-page, we have not simply a compilation, but one with no less

* Since the above was written, Mr. Markham, in a paper read at the Society of Arts, March 27th, 1863, mentions that 35,000 plants have already been ordered by companies and private planters. The reader is referred to that paper for further details on this subject.

pretension than that of a complete work on all thoracic disease, embodying the results of the author's experience and observation; at the same time that he has availed himself of the labours of his predecessors, and admits that he has profited largely by their investigations. Without here entering into the disputed points brought under our notice, we may say that our readers will find the grounds fully stated for any difference of opinion which Dr. Fuller has seen reason to express. It would carry us beyond the limits of available space were we to attempt a critical examination of any of these subjects of controversy; we shall, therefore, content ourselves with stating a few of the prominent features of the treatise, which may appear to us to present originality either in themselves, or in their mode of handling by the author.

In the first place, we would draw attention to our author's mode of putting his conclusions before the reader in a tabulated form, which certainly has the great advantage of clearness and conciseness; and, considering that the work is addressed to the student of medicine as much as to the practitioner, this plan has much to recommend it.

One aim of the author having been to simplify the nomenclature of sounds heard in the chest, we may notice certain remarks to be found with reference to the terms rales and rhonchus, the latter being known as "dry" sounds, as compared with the former, which are appropriately termed "moist" sounds. Although the former are undoubtedly connected with a narrowing of the channels through which the air passes, yet it does not, as Dr. Fuller observes, accurately state the fact to refer the sound to the total absence of secretion, since this very narrowing is often caused by the presence in an air-tube of viscid, tenacious mucus.

"If, for the sake of convenience," Dr. Fuller remarks, "the terms 'râle' and rhonchus' are to be retained, the former should be restricted to sounds of bubbling, the latter to those of vibration. A distinction would thus be drawn between sounds which, though not necessarily indicative of a very different condition of the pulmonary tissue, yet take their origin in a different mechanism."

In the author's opinion, it would simplify our phraseology if the word “sounds” were substituted for “râles" and "rhonchus.”

In the following table, Dr. Fuller has included all varieties of sounds having practical significance, arranged under the two preceding divisions:

When expounding the laws which govern the emission of sounds by the chest under percussion, Dr. Fuller proceeds to explain the cause of certain exceptions to those laws, concerning which he urges that no satisfactory explanation has hitherto been advanced. These exceptions are found in those instances of the emission of sound when the lung is supposed to present the conditions contributing to dulness on percussion, such as the occurrence of a clear high-pitched sound, of a somewhat metallic character, over lung-tissue more or less solidified; and the existence of abnormal resonance in the infra-clavicular regions, the pleural cavity being three parts full of fluid, and the lung thereby partially compressed. The precise character of the sound is apt to vary from day to day, and does not always admit of accurate definition; but it is described by the author as "an abnormally clear but shallow resonance." After having reviewed the various hypotheses that have been put forth to account for the fact referred to, Dr. Fuller adds:

"From a careful consideration of the various circumstances under which this singular phenomenon is met with, I have been led to believe that it arises from the presence of air pent up in lung-tissue, in the immediate vicinity of consolidated tissue-a condition which prevents the diffusion of the vibrations excited by percussion, and leads to the concentration and intensification of the resonance. Nothing can be more certain than that in many cases of pneumonia, especially when accompanied with some amount of capillary bronchitis, the gorged and distended condition of the capillary vessels, and the effusion existing in the terminal bronchi, block up the air-passage from the air-cells, and thus retain in them air in a state of greater or less elastic tension. The post-mortem examinations of persons who have died of pneumonia show this to be a condition of very frequent occurrence. The lung cannot be compressed by any moderate degree of force; little or no air can be squeezed out of it; but no sooner is its tissue cut by the scalpel, than there issues forth a sanious frothy fluid, or, in other words, a fluid largely mixed with air. The portions of the lung in which this exists are those immediately above the point to which hepatization has extended, and below that to which the air has free access. They are those, in short, where crepitation or fine bubbling sounds occur, and are precisely those over which this clear-toned resonance is met with. On several occasions I have traced this resonance shifting its position higher and higher in the chest, as the inflammation has spread upwards, whilst at the same time dulness on percussion has also extended upwards, and has occupied the parts immediately below it, which previously had been the seat of this

clear-toned resonance. In instances of tubercular deposit, the conditions essential to the retention of air in the lung-tissue are of less frequent occurrence, and abnormal resonance over condensed tubercular lung is met with less frequently; but it does occur in certain instances; and it is easy to conceive how some of the smaller bronchi may become occluded either by tenacious secretion, or by the pressure of tuberculous matter; and that the obstruction thus created may, for a time at least, prevent the escape of air from that portion of the lung to which these bronchi lead. And so again in pleurisy, with an abundant secretion into the pleura. Anything, in short, which serves to occlude a bronchus, while as yet the lung beyond the point of obstruction remains even partially distended with air, will tend to produce this abnormal resonance." (p. 59.)

Dr. Fuller supports his pathological inferences by experiments upon sheep's lungs injected and inflated to varying degrees, and eliciting sounds in accordance with the preceding observations. We consider the views of the author, upon these exceptional sounds, to be deserving of attention, worked out with much care, most probably conveying the correct explanation of the phenomenou, and affording an instance of exact induction.

Among the adventitious sounds produced within the chest by the act of breathing, and included in the table already quoted, among the sounds of "bubbling”—the rûles—we find two varieties of the "clicking" sound -viz., dry and moist. Dr. Fuller has convinced himself that it is due to the sudden and forcible passage of air through a small bronchus, the sides of which, at one or more points, have been brought close together by external pressure, or have been agglutinated, as it were, by tenacious mucous secretion. Thus its common cause is the presence of tubercle pressing here and there upon the walls of smaller bronchi, and not only rendering them impervious, but exciting slight local irritation, with the consequent secretion of viscid tenacious mucus. Dry clicking, Dr. Fuller points out, originates in connexion with a very small quantity of viscid secretion, and is met with almost exclusively during inspiration; whilst moist clicking is connected with a somewhat larger quantity of fluid, and though most distinct and constant during inspiration, occurs not infrequently during expiration. In our opinion the explanation thus offered appears sufficiently to clear away the obscurity attending the production of a sound which has been regarded as indicative of the early stage of tubercular softening, but which, taken alone, does not warrant so grave a conclusion. Its persistence and subsequent conversion into other varieties of bubbling, leaves, according to the author, no doubt as to the existence of tubercle.

In the chapter on the resonance of the voice in health and disease, we find many points on which we could dwell with satisfaction, but we restrict ourselves to the author's remarks on ægophony.

With Skoda, Davies, and other experimentalists, Dr. Fuller has found Laennec's explanation of this sound to be insufficient:

"Although they have confirmed to the fullest extent the frequent coexistence of pleuritic effusion and ægophonic resonance-nay, more, though they have proved that in a pure intensely developed and persistent form ægophonic resonance is never met with without the presence of fluid in the pleura, yet they have also shown that effusion may exist without this peculiar vocal resonance; and

63-XXXII.

2