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the muscular tension, which continues untilthe contents of the ventricles are sufficientlyexpelled. This accounts for the sudden

flapping commencement of the first sound,and suggests how the due action of thevalves contributes to its clearness. Theauricular valves, the chordae tendinæ, andthe internal fibres of the ventricles, if theyattain the same degree of tension as theexterior of the ventricles, may have an equalshare in the production of the first sound ;but I am disposed to think that what wehear proceeds chiefly from the contractingtenseness of the external walls of the heart,both because they are nearer to the ear, andbecause, in one observation, the contractionof the left ventricle upon my finger withinit was by no means so abrupt or strong asthat of the exterior, as felt by the otherhand, and still heard through the stetho-scope."

I cannot conceive how Dr. Williams canquestion, whether or not the valves attaina degree of tension equal to that of the mus.cular substance of the ventricles. In a pa-per, in THE LANCET of Jan. 12, 1832, I havedemonstrated that the valves must attain asnore abrupt and a greater tension than thesubstance of the ventricles, and I feel confi-dent that Dr. Williams’s acquaintance withphysics would, after a short consideration onthe point, lead him to the same conclusions.Dr. Williams should remember, that his

finger trammelled the action of the veryvalve whose degree of tension he assumesit to have measured. The ingenious argu-ments, in the latter part of the above quo-tation, appear to me to involve a petitioprincipiz; they certainly do, if Dr. Williamswould wish to infer that the first sound isnot of valvular origin, because the soundheard by the ear, is that occurring in theexternal fibres of the ventricles; for, thequestion is not, Where are the vibrations ?but, What is the cause of those vibrations ?

Again: "The cause, of sound is resistedmotion; and the strongest and quickest mo-tion, most abruptly a.nd forcibly resisted,will give the loudest sound. Hence theventricles, rapidly contracting from theirflaccid state, give most sound when theirmotion is first resisted by the mass andweight of the blood within them, which isconfined within the auricular valves."And when, I would ask, is the motion

*’ first resisted ?" Why, when the valvesclose. And when is the blood " first con-fined ?" Why, when the valves close) Ergo,Dr. Williams conceives that his explanation,given in 1828, that the first sound is a mus-cular sound, was correct. Really, this ap-pears to me to be a decided non sequitur.Dr. Williams further argues, that the abovethree-explanations of Dr. Hope are all contain-ed in "one simple principle,"—that of suddentension. This, I think, is perfectly correct ;but I cannot allow that this principle- is

contained in any of Dr. Williams’s previousexpositions of the heart’s sounds, nor thatthe above explanations are applicable tomuscular sound; but I think the readerwill perceive that all the above explana-tions are resolvable into that given by mein THE LANCET of Sept. 23, 1833, ia a pawper to which Drs. Williams and Hope havereferred, and from which the following quo.tation is taken :-" Any flexible solid, suddenly brought

from a state of relaxation to a state of ten-

sion, vibrates, and its vibrations are sono-rous or not-i. e. audible or not, accordingto its physical structure. At the commence-ment of the systole of the ventricles, theirauricular valves are flapped into play, and,at the instant of their closure, the wholesubstance of the ventricles and the valves are

suddenly brought to a state of tension, andthen, consequently, they vibrate. I leaveit to the reader to determine whether thevibrations of the valves, or of the muscularsubstance of the ventricles, would mostcontribute to the formation of the firstsound." ’

The objections advanced by Drs. Hope,Williams, Bouillaud, and other writers, maybe valid, and may apply to the theory of M.Rouanet, but they do not apply to mine. Iremain, Sir, your obedient servant,

E. L. BRYAN.Stow market, Feb. 23, 1836.

E. L. BRYAN.

GERMAN JOURNALS.

PRESS of matter prevents us from passingin review all the articles contained in thelast numbers of the German journals whichwe have received; we shall, therefore, can..tent ourselves with an enumeration of their

contents, and a brief notice of the most im.portant papers to be found amongst them.

Hecker’s Annalen, Vol. II. Nos. 3 and 4;and Vol. III. No. 1.

1. On the Influence of Trades and Pro-fessions on the Health and Mortality of aPopulation. Part 1. By Dr. FUCHS. Weshall wait until the second part is publishedbefore giving an account of this interestingmemoir.

2. On Gastro-enteritis. By Dr. KOHLERof La Charité.

3. ON SCARLATINA.

By Professor LICHTENSTADT of Berlin,St. Petersburgh.

This is a long memoir, containing an ac-count of the epidemic scarlatina which pre-

ivailed in St. Petersburgh in the winter 1834-35. The author, agreeing with most wri-

ters, considers scarlatina as a disease which

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is eminently contagious ; he cites severalcases, where it was transmitted from houseto house through the medium of visitors,who themselves remained unaffected; how-ever, by using proper precautions, he wasalways fortunate enough to avoid the dan-ger. The period of contagion is often pro-tracted to a very considerable length oftime; the professor was accustomed to con-sider six weeks as the maximum, but duringthis epidemic the disease was evidentlytransmitted from one individual to another,at the distance of eight weeks from thecommencement of the attack; a long-con-tinued exfoliation of the epidermis seems tofavour the prolongation of the contagiousperiod. The only method of checking thedisease, is to avoid as much as possible allcircumstances by which its contagious pro-perty may be propagated. Dr. Lichten-stadt has experimented with belladonna-a remedy much praised latterly as a pre-ventive, but without any good effect.The march of scarlatina may be divided

into three periods; that of invasion, that oferuption, and, finally, the period of desqua-mation. The first rarely lasts beyondtwenty-four hours; as a general rule, it may be laiddown that the disease is dangerous in pro-portion to the shortness of the first period;however, this admits of several exceptions.The second period, or that of eruption,

lasts usually from seven to nine days, un-less it is cut short by the child’s death. Inthe latter case it may terminate in eighteenhours (one example of which kind the au-thor observed), or in thirty-six hours afterthe commencement ofthe period. The colourand extent of the eruption are very various.Some writers advance that a deep-red colour,uniformly spread over the whole body, is afavourable sign; on the contrary, the authorthinks the danger is always increased inproportion to the intensity of the eruption.The pulse, as is usual in this disease, was I

always quick, and not reduced by the ap-pearance of the eruption ; at 100, it was notan unfavourable symptom ; the pulse oftenrose to 120, and this also without indicatingany great danger ; but the disease was al-

ways the more grave and fatal, in propor-tion as the pulse exceeded this latter degreeof frequency.Bloody evacuations were sometimes ob.

served during the course of this period, bu1they did not seem toexercise any remarkableinfluence in its march or termination :several children were seized with epistaxis,some recovered ; others died. One patient,who died on the fourth day after copiousloss of blood from the nose, was seized

thirty-six hours later with violent hemor-rhage from the vagina. The indicationsdrawn from an examination of the urine, oralimentary excretion, do not present any-thing remarkable. The state of the tonguehas always been considered of great import-

ance, especially for the diagnosis of scarla-tina. We have almost invariably observedthe red, developed papillae, at a very earlystage; however, the author says, in thepresent epidemic, for the first few days afterthe appearance of the eruption, the tonguewas covered with a whitish, or a yellow-

white fur, by no means characteristic ofscarlatina, and not differing from that ob-served in common fevers; however, the an.terior portion and edges of the tongue gra-dually assumed a reddish colour, which soonacquired the true scarlatina tint.Some cases of gangrene of the fauces

were observed, but the author saw hardlyany example of the diphtheritic inflarnina-tion,described by BRETONNEAU as extendingto the pharynx and larynx. In one case thisgangrenous inflammation was complicatedwith croup. In several cases also, espe-cially towards the end of the epidemic, theauthor observed a ringing cough excessivelylike croup, but all these terminated favour-ably. The duration of the desquamatingperiod is various. In some cases the de-squamation was not completed six weeksafter the commencement of the disease; inothers it was still more protracted. Thecomplication of this period was, as usual,anasarca; general anasarca and abdominaldropsy often occurred, but never in a fatalform: one case of fatal thoracic effusionpresented itself in the case of a child four

years old; the cavity of the chest containedtwo pounds of clear fluid. No case of acuteeffusion into the cavity of the skull wasobserved.The treatment pursued by the author

seems very rational, and does not differ inany remarkable manner from that whichwould be adopted in this country. He

justly condemns the antiphlogistic method,when pushed to too great an extent, prefer-ring mild cooling regimen, and a moderateuse of blood-letting when absolutely neces-sary. The experiments which he maclewith cold affusion do not seem to have givenvery favourable results, and he prefers rub-bing the skin with warm oil. The inflarn-mation of the throat did not appear to bealleviated in the least degree by leeches, andpurgatives with emetics had not a muchbetter e1fect. In a word, the result of theauthor’s observations on the treatment ofthe second period is, 11 that medicine is onlyof negative value, and that when a cure

does take place, we are indebted to naturefor the fortunate result."

THE MOTOR AND SENTIENTNERVES.

4. De Differentia et Nexu inter NervosVitae Animalis et Vitas Organicse. By J.VAN DEEN. Lugd. Batav. 1834.THE fourth article has the above title.

After a short description of the difference