November i i, 1897] 



NA TURE 



imperfection. His lectures, like Sir Thomas Watson's 

 and others that are placed among the classics of medi- 

 cine, do not contain a complete statement of all that can 

 be said on their subject ; but they do excite the reader's 

 interest, they do arrest his attention, they make him per- 

 force reflect for himself, and they in this way truly 

 subserve his education in the best sense of that much- 

 abused word. 



The lectures must have been delightful to listen to ; 

 every sentence bears the impress of their author's genial 

 personality. Nothing connected with drugs and their 

 actions is without interest to him ; and he assumes, and 

 rightly assumes, that his hearers must share his interest. 

 His style is artistically simple and direct ; allusions, 

 illustrations, analogies, experiences, anecdotes, are intro- 

 duced at every turn, and the light of his gentle humour 

 plays effectively over many a passage. The old-fashioned 

 materia medica lecture used to be regarded as the driest 

 and dullest of the medical course : Dr. Brunton has trans- 

 figured it into one of the brightest. It is his special merit 

 that the change has been brought about without the least 

 sacrifice of scientific method or scientific precision ; for 

 the whole book is instinct with the spirit of modern 

 physiology and pathology. Empirical axioviata media 

 cannot yet be wholly excluded from therapeutics, but 

 Dr. Brunton is never content with a mere induction from 

 experience when it is possible to suggest a rational 

 explanation. And if the suggestion is capable of being 

 tested by experiment, the experiment is made. 



" I was once demonstrating the action of ammonia 

 before a class here many years ago, and showed that if 

 you held either ammonia or chloroform before the nose 

 of a rabbit the heart stopped instantaneously. This 

 stoppage of the heart takes place reflexly through the 

 fifth nerve as an afferent, and through the vagus as an 

 efferent nerve. After the lecture was over, a student 

 came up to me and said : ' If ammonia held before the 

 nose stops the heart, how is it that it is of use in faint- 

 ing? It ought to be exceedingly bad in fainting, and 

 yet everybody knows it is good.' Well, I simply did not 

 know. I said : ' I think it may possibly be that it tends 

 at the same time to cause a deep inspiration, and thus 

 stimulates the heart indirectly.' But I was not satisfied 

 with this explanation, and so I put the question to the 

 test of experiment. I found the answer to be this : At 

 the same time that you stop the heart through the vagus 

 by ammonia or any other irritating volatile substance 

 held before the nose, you stimulate reflexly the vaso- 

 motor centre, cause contraction of the arterioles, and 

 raise the blood-pressure enormously." 



This specimen is typical ; it can be paralleled by a 

 multitude of others, and it exemplifies at once the style 

 and the spirit of Dr. Brunton's teaching. 



The general plan of the book follows the lines of the 

 schedule recently adopted by the Royal College of 

 Physicians as defining the scope of an examination in 

 pharmacology for students aspiring to their licence. 

 Before, however, any examination had been held, a re- 

 trograde step was taken by a majority of the Fellows, 

 and this special examination was abolished. Among the 

 grounds alleged for so unusual a course were the supposed 

 vagueness of the limits of the science, and the absence 

 of appropriate te.xt-books. It cannot be doubted that, 

 had the present work been then accessible to students, 

 NO. 1463, VOL. 57] 



these grounds of objection would have proved untenable. 

 " The action of medicinal agents on the body in health 

 and disease " forms, indeed, the essential scientific 

 foundation for the " practical art of therapeutics " which 

 every medical licentiate is assumed to have acquired ; 

 without this foundation he must needs be a mere em- 

 piric. The author has shown that the ascertainable 

 facts in reference to medicinal action constitute already 

 a coherent and orderly body of knowledge, and that 

 future progress in rational treatment is dependent on 

 the pursuit of the methods of scientific pharmacology in 

 this sense of the term. He has furnished the student 

 with an excellent guide to both facts and methods, and 

 has thus removed the last excuse for the maintenance 

 of mere rule-of-thumb tradition. It is to be hoped that, 

 at no distant day, the Royal College will reconsider its 

 last decision in the light of better knowledge and broader 

 conceptions of medical education. 



In accordance with the plan of the above-mentioned 

 schedule, the actions of medicines are first considered 

 from a physiological point of view, as they affect the 

 various functions and systems of the body, normal or 

 morbid. The movements of the alimentary canal and 

 digestion ; the composition of the blood, nutrition and 

 metabolism ; the heart and blood-vessels, and the circu- 

 lation ; disorders of the circulatory function, such as in- 

 flammation ; absorption of inflammatory products ; secre- 

 tion and excretion ; respiration ; the nervous system and 

 sleep ; the sensory functions and pain ; the reflex and 

 motor activities of the nervous system ; the regulation 

 of bodily temperature and fever ; specific poisons and 

 infections ; all of these are capable of being altered, 

 modified, or controlled by medicinal agents, and the mode 

 in which the latter exert their special action and produce 

 their recognised effects is fully set forth. 



But in many cases the practitioner has to ask himself 

 not only what agents at his command are capable of 

 modifying a given function in a desired way, but also 

 what organs or functions may be affected by a given 

 remedy administered in a particular manner. It is 

 therefore necessary again to traverse the ground, at 

 least in part, arranging the subject-matter under the 

 heads of the chief medicines and therapeutic methods in 

 ordinary use, and summarising their numerous primary 

 and secondary actions on the body at large. The last 

 half-dozen chapters do this clearly and succinctly. There 

 is perforce some repetition of the earlier chapters ; but 

 the student is made to feel that not a page could be 

 dispensed with, and the book ends long before his atten- 

 tion is fatigued or his interest exhausted. 



It would, however, be a mistake to regard the book 

 as good for students only : it is full of wise aphorisms 

 and sagacious hints of the greatest value to men engaged 

 in actual practice. There is scarcely a page from which 

 even a practitioner of long and wide experience could 

 not cull a suggestion, leading to the better use of his 

 . familiar tools, or to the elucidation of some old-standing 

 I puzzle. Alike to the student who is learning the subject 

 for the first time, to the medical man in search of light and 

 leading in the perplexities of treatment, and to the " in- 

 telligent reader" who desires to appreciate the advances 

 j made by modern medicine to a place among the sciences, 

 I we can cordially commend this fascinating work. 



