CAN A WOMAN REMAIN IGNORANT OF HER PREGNANCY UP TO THE TIME OF HER DELIVERY?
643 we judge from the Preface that he personally knows "the horrors of asthma," and we may safely say that he writes well. There was ample room for a good treatise upon the disease in question, to be written by a scientific and practical physician, who should review our accumulated clinical experience by the light of modern physiology and pathology, and at the same time be enabled to add something derived from direct personal observation. The hiatus has been filled in a very satisfactory
... No one who reads Dr. Salter's work can doubt for a moment that he is master of his subject. So far as science permits, a progression is here made, whether as regards the general clinical history, the pathology, or the treatment of this affection. We do not think anything further could be at present satisfactorily said. Independently of the merely professional merits of the book, however, we are bound to say that it is written in so fluent and natural a style as to render its, perusal as pleasant as it is profitable. That the work will become popular there cannot be a doubt, and when we state that it has a right to take its stand side by side with Budd on the Liver, Brinton on the Stomach, Bird on Urinary Deposits, Fuller on Rheumatism, and Garrod on Gout, we .award it a position to which it is in every way entitled. For some time past the author has been laying before the profession, through the medium of different journals, the general views he has arrived at on the subject of asthma, and which form the more central ideas of this his substantive work. It may not be out of place, however, to briefly indicate here what are the leading principles which are once more affirmed. In the first place, Dr. Salter coincides with several well-known pathologists in maintaining that asthma is essentially a nervous disease, the phenomena of which depend upon a spastic contraction of the unstriped muscles of the bronchial tubes, and which contraction is of an excito-motory or reflex kind ; that this is an idiopathic, uncomplicated spasmodic asthma existing in most cases, at first, unassociated with any necessary or essential anatomic lesion, but that, if it becomes established and repeated in the patient, then it has a direct tendency to disorganize. It hence results that asthma is constantly seen allied with prominent morbid structural alterations, such as changes of the bronchial tubes, of the lungs, of the heart, ac. so that emphysema, for example, is not to be looked upon as the cause of asthma, but as the effect of it. The most obscure and difficult part of the subject is the etiology of the disease. The causes of it, however, must be regarded as of two kinds-viz., the causes of the paroxysms and the causes of the disease. The first are the immediate provocatives of the attacks, the second are the original and essential occasion of the asthmatic tendency. To seize the former is often an easy task; to point out the latter-that is to say, what has originally rendered the individual asthmatic, what it is that has disposed him from time to time to fall into the asthmatic state on the occurrence of the exciting cause of the attacks-is altogether as difficult. The author steers " a middle course between those who say that asthma has at the root of it some organic disease within the chest, and those who deny that genuine spasmodic asthma ever depends on organic lung disease, and maintain that it is always a pure neurosis."-p. 134. Dr. Salter affirms that "asthma never kills;" at least he has never seen a case in which a paroxysm proved fatal. When a patient dies from the contingencies of the disorder, he does so from the organic changes in the heart and lungs which have gradually progressed. As regards the prognosis of the disease, an unfavourable inference must be drawn from the persistence of expectoration, or from the presence of chronic cough. Both these symptoms show that the lining membrane of the air passages is the seat of organic change:-" If the patient is young, the chest sound, the attacks short, the intervals long; if there is no permanent shortness of breath, no cough or expectoration; if the attacks are getting milder or rarer, and if the exciting cause is clear and such as may be obviated, then a favourable prognosis may be given...... If the patient is old, the lungs damaged, the attacks frequent and severe, the breathing never quite free, coughing and spitting constant, the disease apparently gaining ground, and the exciting cause occult or irremediable, then, quoad all or any of these circumstances, there is no alternative but to give an unfavourable prognosis."-p. 279. The treatment of asthma, like that of all paroxysmal diseases, presents two phases-viz., one that pertains to the treatment of the dyspnoeal fits, and one that relates to the treatment of the patient in the intervals. The therapeia of the former consist in the employment of certain depressants, sedatives, and stimulants, and the inhalation of particular fumes and gases. That of the latter is chiefly hygienic, being composed mainly-of dietetic and regimental procedures and climatorial elements. All the points here involved, and numerous related topics, are, as we have before implied, most efficiently and clearly worked out by Dr. Salter. Whilst we are of opinion that he somewhat overrates the novelty and originality of many of his leading principles, as also his illustrations, we willingly allow that he has so treated his subject as to have furnished the profession with such a p·eszcme of the nature and management of asthma as will place him amongst a high class of medical writers.