« ПредишнаНапред »
power of the pure alkali, while they must be less injurious to the digestive organs, and it is still undecided whether the caustic alkali can be employed so as to dissolve the stone.He concludes his chapter on caloulus by giving an account of the method proposed by Fourcroy for removing these substances, by injecting solvents into the bladder. It is a proposal that has been frequently suggested, and which bears a plausible appearance : but it has not been found to produce the expected advantages, when actually put in practice. This tailure de-, pends, no doubt, in' some degree, on the fact that the attempts formerly made did not proceed on the scientific principles which are now so clearly established by the modern discoveries in chemistry. On the whole, however, it is a practice which, we apprehend, will seldom be adopted: but, should it ever be tried, we think that the directions of M, Fourcroy are in all respects worthy of our attention.
Chap:ers II. and III. treat on the diseases of the bladder and the prostate gland. These affections are less frequent in their occurrence, and are marked by less decisive symptoms, than those which form the subject of the first chapter; their cure is also less certain ; and palliative nieasures are often the only steps that we can take. In the diseases of the bladder, Mr. J. directs the attention of the practitioner to the use of the uva ursi ; a remedy which has by some been much extolled, but which at present is not regarded as being possessed of much efficacy.
In the 4th chapter, Mr. Johnston discusses the important subject of stricture in the urethra ; detailing the symptoms of the disease with accuracy, and examining the degree of success that has attended the different means recoinmended for its re. moval. He is himself a decided advocate for the use of caustics, and endeavours to obviate the objections that have been urged against them. His remarks are candid and judicious, and for the most part very exactly coincide with the opinion that we have been induced to form on the same subject. The only point in which we are disposed to differ relates to the propriety of employing the lunar caustic in the less frequent variety of the disease, in which the stricture consists of a long irregular contraction of the canal. Here, we apprehend, the bougie might be adopted with more advantage ; or, if any caustic be applied, we should be inclined to use the kali purum, as recommended by Mr. Whately.
We shall only add that we have perused Mr. Johnston's trea. tise with much satisfaction; and we would especially recom. mend it to the young practitioner, as a safe guide for forming his judgment, and directing his operacions, in a class of intricate and important diseases. Rev. May, 1808
ART. Arr. VIII. A System of Operative Surgery, founded on the Basis of ! Anatomy. By Charles Bell. Vol I. Royal 8vo. pp. 480. and • many plates. 1ts. boards. Longman and Co. 1807.
from the preface to this volume, we learn that its design is, T in some respects, different from that of any publication which has hitherto been given to the world. Mr. Bell states that his intention is to present to the student, and to the surgeon, such clear, short, and strong views of the objects of our operation; of the manner of operating ; and of the difficulties which may unexpectedly present themselves as an experienced surgeon would wish to impress on the mind of one in whom he is much interested such a view, in short, of operative surgery, as, without putting aside the information gained in general study, may guard against the distraction of difficulties and doubts, when the knife is actually in the hand.' That the object which Mr. Bell proposes to himself is possessed of some peculiar advantages, we are ready to admit : but we confess that it is not clear to us whether these are not more than counterbalanced by corresponding disadvantages. The work, as far as it is now executed, certainly impresses us, through all its parts, with the idea of something imperfect. The information conveyed by it is not sufficiently ample to supersede the regulas elementary systems ; nor is it so far original as to be perused with any great interest by those who have passed through their noviciate. It indeed contains many sensible remarks, and some valuable hints, that may lead to future improvements in practice; but with these is blended a large proportion of matter which, without being exceptionable, is rather common-place. In passing this judgment, which may perhaps be deemed too severe, we are influenced, in some measure, by the opinion which we had formed of the author's talents, from his previous publications: for we acknowlege that, in the present instance, the sight of Mr. Charles Bell's pame in the title page raised expectations which were not altogether justified by a perusal of the treatise.
After some introductory remarks on wounds, we have a chapter devoted to the operation of bleeding in the arm, with the accidents which sometimes succeed it; and afterward one on aneurism. They are intitled to the negative commendation of containing nothing that is objectionable: but they do not entirely correspond to the idea that we were led to form of a work which directly professes to be original. We must, however, except the information contained in one of the notes, re. specting the success of Mr. Lyon's practice in the operation for popliteal aneurism; which we apprehend to be much
greater than that which usually falls to the lot of any operator, and which is the more interesting, as it would seem to depend on the employment of a new but very simple expedient :
"Mr. Lynn, of the Westminster hospital, has performed the operation for aneurism in the fore part of the thigh, eleven 'times in Mr. Hunter's manner, and only one of the patients he lost from hæmorrhagy, owing to the bursting of the artery. He argues thus: “ when I have dissected the arteries of the thigh in the dead body, I find that on bending the thigh, the arteries hang loose, and are too long for the thigh, and do not. keep their places; therefore, I conceive that after the operation for aneurism, I am enabled by managing the position of the thigh alone, keeping it easily relaxed, to give full freedom for the artery to contract without cutting it across."
The third chapter, on stricture in the urethra, has more claim on our attention, on account of its containing a suggestion which, we think, may prove of considerable practical utility. Mr. Bell conceives that strictures do not always possess the form that was described by Mr. Hunter, but that they occasionally consist of a long irregular contraction, an inch or more in length. To this last species of the disease, he justly thinks that the lunar caustic is an improper application, and recommends the use of the kali purum. (See p. 49 of this Rev.) It hence becomes a matter of importance to distinguish between the two varieties of the disease, and in order to accom. plish this object, he has invented an instrument, which con. sists of a metallic ball, fixed to the end of a wire. By having balls of different sizes, and by noticing the circumstances which attend their passage along the canal, we may form a tolerably accurate judgment of the size and extent of the obstruction.
Our attention is next called to observations on hæmorrhoidal tumors, affections of the uterus, hydrocele, polypus nasi, and some other complaints of minor importance; and then we come to the subject of hernia. This is treated in an ample manner; and the account of the disease, and of the means employed for its removal, is correct and judicious. Still, however, we do not meet with much information that is not contained in other publications; so that, notwithstanding the accuracy of Mr. Bell's dem scriptions, and the good sense which is manifested in his advice, we feel a degree of disappointment at finding, in a production like the present, so little that can lay any claim to originality. We remark, indeed, one idea which the author strongly enforces, and which he seems to regard as peculiar to himself, that the immediate cause of death in hernia is not from obstruction in the bowels, bur from inflaınmation brought on in the higher part of the intestine, in consequence of its efforts to propel its
contents. We are, however, inclined to think that, if Mr. Bell had not determined to write without consulting his library, he might have found the same doctrine very fully laid down by some of his contemporaries.-Several good observations occur on the nature of the sac, and on the part which immediately forms the stricture. This, Mr. Bell supposes, is generally produced not by the tendons of the ring, but by the mouth of the sac; and he argues strongly in favor of freely opening this part. He remarks on Mr. Cooper's method of operating, which consists in passing the knife between the ring and the sac, that it is not always practicable; and, when it is done, that it is frequently ineffectual. As an objection to cutting into the mouth of the sac, it has been stated that, by this mode, inflammation is apt to be induced on the peritoneum, which may spread along the cavity of the abdomen and prove fatal: but Mr. Bell inclines to the opinion that, when inflammation supervenes in these instances, it has its origin in the intestines themselves. He acknowleges, however, that this is a point which requires farther elucidation.
In the chapter on femoral heroia, the author is desirous of proving, that the part which has been lately described under the title of the femoral ligament, and brought forwards as something either not before known or not adequately noticed, was well understood by Mr. Pott; and that, in his own “ Dissections," a description is given of it more accurate than any which has been since published. We are sorry to feel outselves obliged to differ from Mr. Bell on this subject. We have examined the passages in his former work, (which we highly esteem,) and we have considered the remarks of Mr. Pott:--but the conclusion that we must draw from them is, that they neither of them express the true anatomy of the parts. Both Mr. Pott and Mr. Bell were aware of some peculiarity in the form of the tendon of the external oblique muscle, but they were not so thoroughly acquainted with its nature as to be able to state precisely its extent, or the influence which it would have over the operation. In this precision it is that the merit of M. Gimbernat and Mr. Heç consists.
We have then an interesting chapter on lithotomy; an operation to which the author appears to have paid great attention. He describes it as it is usually performed with the gorget, and afterward gives an account of the method which has been lately practised by Mr. Lynn and Mr. Carlisle, in the Westminster hospital; who have revived the operation of Frere Cosme, which consists in passing the concealed bistoury into * the bladder, instead of the gorget. Mr. Bell objects to both these operations, on the principle of their being too mechanical, proceeding precisely in the same manner, and employe ing exactly the same kind of motions indiscriminately in all instances, without any regard to the peculiarities of structure, or the nature of the particular case. For this reason he gives a decided preference to the knife, and describes an operation which is certainly more simple and more scientific; and which we should undoubtedly recommend, were lithotomy always to be performed by skilsul anatomists: but we are inclined to think that, in vulgar hands, the gorget is the safer instrument.
We shall quote Mr. Bell's account of his operation:
• The staff is kept in the centre, and well home into the bladder. The surgeon, making his incision under the arch of the pubes, and by the side of the apus, carries it deeper towards the face of the prostate gland ; cutting near to the staff, but yet not cutting into it, and avoiding the rectum, by pressing it down with the finger.
• Now, carrying the finger along the staff, the prostate gland is felt. The point of the knife is run somewhat obliquely into the urethra, and into the lateral groove of the staff, just before the pros. tate gland.
The knife is run on in the groove of the staff, until the urine flows. The fore-finger follows the knife, and is slipped along the back of it, until it is in the bladder.
• Having carried the fore finger into the bladder, it is kept thers, and the knife is withdrawn; then, directed by the finger, the forceps are introduced into the bladder. ! . If the stone is not readily caught betwixt the blades of the fore ceps, the finger is passed into the anus, which, lifting up the lower part of the bladder, the stone is put within the grasp of the forceps, and assisted in its exit, if it be of great size.'
Four chapters on amputation are added, and two on injuries of the head, the latter of which contain many valuable observations.
ART IX. Dissertations on Man, Philosophical, Physiological, and
Political; in Answer to Mr. Malthus's “ Essay on the Principle of Population.” By T. Jarro d, M.D. 8vo. PP. 367, 108. od.
boards. Cadell and Davies. Art X. A Reply to the Essay on Poçulation, by the Rev T. R. Mal
thus. In a series of Letters. To which are added Extracts from the Essay; with Notes. 8vo. pp. 378. 8s. boards. Longman and Co. The judgment which we pronounced on Mr. Malthus's
performance has been ratified by public opinion : its mesits have been almost universally acknowleged; and the prin