it is entirely separated, and a portion of the whole cylinder comes away. In this case Mr. Cooper advises to cut away the whole of the diseased part above and below, to reunite the intestine by sutures, and to return the whole into the abdomen. Some curious experiments on dogs, which he relates partly from his own observation, and partly from similar trials made by Mr. Thompson of Edinburgh, shew that a divided intestine again united by ligature will entirely heal, preserving the natural canal, and in the dog producing even very little inflammation or apparent inconvenience during the process. The other circumstances of these experiments are very

curious.

Very large irreducible hernia, when strangulated, are difficult and dangerous to treat. The great adhesion which commonly takes place by length of time between the omentum and intestine in the irreducible portion, and between these and the sac, oppose often an insuperable obstacle to their return when the operation is performed. Under these circumstances Dr. Monro has advised in his lectures that the sac be not opened, but only that an incision be made at the ring on the outside of the sac, with a view simply of relieving the strangulation, and allowing the fresh portion of descended intestine to return. Mr. Cooper strongly recommends the same practice, and gives two very instructive cases in support of this opinion.

Of the varieties of bubonocele, the most important is that which emerges from the abdomen immediately opposite to the abdominal ring. This has been described for many years at the lectures in St. Thomas's and Guy's hospitals, and examples of it are now pretty frequent in anatomical collections. In operating, the great danger in this case is that of wounding the epigastric artery (generally a fatal accident) which in this variety lies on the outside of the tumour, nearer to the ilium, and therefore would be exactly in the way of the bistory in the usual direction in which the stricture is

dilated. This is avoided by dilating in aff cases, as Mr. Cooper advises, directly upwards. It also appears from two cases here given, that even in bubonocele, with all the common appearances, the epigastric artery sometimes takes this unusual direction, and therefore a fatal accident may take place from the common mode of dilatation without any fault of the surgeon; as from a wound in the same artery in the common place for puncture in tapping. A very rare anomaly of congenital hernia is given from Mr. Forster, senior surgeon to Guy's hospital, in which the upper opening of the ab domen remained open, but the ring was closed; so that the hernia descending in the direction of the spermatic cord was truly congenital, or contained within the tunica vaginalis, but also enclosed in a proper sac. A similar case is related by Mr. Hey, of Leeds, in his excellent sur gical memoirs.

The general style and manner of this publication is that of the lecture-room, where the object is rather to convey direct instruction in concise and simple language, than to enter into the discus sion of difficult and disputed points. The reader that consults it for information, will generally find all that the operating surgeon can want; whilst the practice of two large hospitals for a nuber of years, together with the opportu nities afforded by a considerable school of anatomy, probably include almost all the varieties that are likely to be met with in this very important part of sur gery.

The plates added to this splendid work are cleven in number; the engraver has done ample justice to the draughtsman. and the latter to the preparations that were set before him. The subject could not have been well explained without the assistance of plates, and these are numerous, well selected, executed apparently with great accuracy, and as large as life. In intrinsic value and beauty of execu tion they will stand a comparison with the most esteemed specimens of anatomi cal engravings.

WITH this volume Mr. Bell concludes his arduous undertaking of de scribing the whole anatomy of the human body. The contents of this volume

are, the viscera of the abdomen and pelvis, the lymphatic system, the veins, and the structure of the teeth, together with some collateral matter.

It would be injustice to Mr. Bell to confound this work with the ordinary compilations from the common stock of elementary writers, and the transcribed lectures of the class-room. It is obviously the result of very extensive study both in books and in the dissecting-room, and its completion now supplies a want which was much felt by the English

reader.

Any analysis of the contents of this volume would be superfluous; in the parts that we have examined, the description is clear and accurate, and the engraved sketches occasionally introduced are often very happily devised in assisting the reader to gain a full idea of the relative situation of important and complicated parts of anatomy. They add much to its sterling value as a comprehensive and well-executed system of anatomy.

What there is of originality in these volumes, chiefly, if not entirely, consists of occasional remarks on the theories formed by eminent men concerning the functions of different parts of the system, and of some addition to the stock of ingepious conjecture. We must think, however, that when the author quits the descriptive for the theoretical part, he shews himself much more acute in detecting inconsistencies in others than in supplying their deficiencies by luminous conjecture or happy analogy. Nor is he entirely free from the very common fault of exaggerating the weak part of those opinions on which he wishes to fix a ridicule, and weakening the force of the arguments of his predecessors when they approach too near to his own. His speculations on the use of the spleen and of the lymphatics afford instances of both these errors. For example, the following is the way in which he represents Mr. Hunter's opinion on the functions of the absorbent system.

"Mr. Hunter has given to the lymphatics not only the grovelling qualities of animals, as eating, but the higher attributes of intellect. They do nothing without forethought and intention; when they absorb, it is because they have found the parts useless in the economy. He has carried this notion so far, that he does not only speak of the absorption of the thymus gland, membrana pupillaris, alveoli of the teeth, &c. but of the body in fever as a consequence of its becoming useless when under disease!"

We do not mean now to defend the. consistency of Hunter's opinions, but it is somewhat of exaggeration to infer from them that he allowed to the absorbent system "the higher qualities of intellect," or that the inherent power of selection and rejection which he gives to. them is the result of thought, or is actuated by metaphysical motives. At any rate, it is singular that he should have chosen this hypothesis as a mark for ridicule, when in his own explanation of the functions of the capillary vessels he has transplanted to them this very opinion of a discriminating appetency for certain substances to the exclusion of the rest, between which and Hunter's hypothesis but a hair's-breadth of difference can be fairly deduced. The fol lowing are his words.

"The capillary vessels are those extreme branches which are as minute as hairs; but this, though the literal, is not the general meaning of the term. By capillary vessels is rather understood those branches in which the changes are wrought from the blood, and which are either so minute as not to allow the promiscuous flow of the blood, or possessed of such a degree of irritability and appetency, as only to allow certain parts of

that fluid to be transmitted.

is no exudation; but no sooner is the animal "It is proved that in the living body there dead, than the fluids exude from the vessels, the secretions pass through the coats of those receptacles which formerly contained them. and the whole parts partake of an universal colour. From this simple fact we are led to think that a property exists in the living fibre, which by contraction or some other property natural to suppose that the fibres, and more repels the fluids. Admitting this, it is very particularly the vessels, have a discriminating property; so that the capillary texture of each organ possesses sensibility, which has its relations to the fluids passing through them, or to be secreted from them."

The following general view of the long-disputed question of venous absorption is interesting, and well drawn up.

"In this general account of the venous system, it remains only to speak of the subject of absorption. Before the suite of experiments made on this subject by Mr. Hun. ter, a vague notion was entertained that the veins were absorbents; but about that time*, the doctrine that lymphatics are absorbents having been established, the opinion that the red veins were also absorbents was first questioned, and finally confated, at least in the opinion of most physiologists.

The cases for which the alkaline caustic is recommended are precisely those

in which the lunar caustic is resorted to; nor is there any material difference in the mode in which the bougie is prepared for this purpose. In both the caustic is fixed firmly into the end of the bougie, and is of such small dimensions that it cannot come in contact with any other part of the urethra than that in which the stricture exists, except by being dissolved in the mucus, or injudiciously applied. The quantity of the kali recommended by Mr. Whately is no more than a piece of the size of a pin's head. The precautions to be taken, and all the minutiae of the mode of using this application (of the utmost importance in practice), are detailed and described with great precision.

The author attempts, but with very little success, to explain the reason of the superior mildness of the kali over the lunar caustic, chiefly from nicety of the manipulation, and the mode which he recommends of passing the bougie backwards and forwards through the stricture, with a view of abrading its sides without proceeding to such an extent of action as to form a slough. The following are his words.

"Before the kali purum can be safely taken into the stomach, its caustic properties must be entirely destroyed by dilution; but, under proper management, it may be applied to the urethra, even as a caustic, without producing a slough, as it commonly does when applied in the usual method. The mode of applying it on the extremity of a bougie, which is gently moved backwards and forwards, and the time that the caustic may be supposed to be in the act of dissolving, have been already explained. By this procedure the kali is equally diffused over every part of the strictured surface, and only abrades the membrane of the stricture, with out producing a slough. The degree of this abrasion is entirely under the controul of the operator; by a hitle attention to the quantity of caustic employed, it may be increased or lessened at each application, as circumstances dictate. In this operation a slimy substance is formed, compounded probably of the abraded matter of the stricture, and the oil and lard used in the operation, combined with the kali. This slime is found adhering to the bougie, and some of it generally finds its way down to that part of it which is held by the operator's hand. In ANN. REV. VOL. III.

this manner the kali penetrates and dissolves the hard and diseased surface of a stricture, with a facility which no other remedy, that can be safely applied, will equal. That this is the mode of its action, when applied' as directed, I am convinced from oc lar demonstration; for, in applying it to a stricture near the orifice of the urethra, I have had frequent opportunities of remarking the degree of abrasion it produced without occasioning slough, together with the formation of the saponaceous slime I have mentioned.”

All this elaborate explanation of the action of the kali is mighty trifling, when it is considered that the piece of alkali is no more than the size of a small pin's head. How the slime formed by its union with the lard used to fix it on the

bougie can be distinguished, both from ed, and from the natural mucus of the the oil with which the bougie is smearbladder, we are utterly unable to con ceive. Nevertheless, the fact may probably be, that the alkali gives less pain

than the lunar caustic.

it laid down as a general rule by the We were somewhat surprised to see author, that

"In every case of stricture, before we apply this remedy, we ought to be able to pass a bougie into the bladder of at least a size larger than one of the finest kind. This is necessary both to enable us to apply the caustic to the whole surface of the stricture, and likewise to put it into our power to remove a suppression of urine, should it occur, during the use of the caustic. In the greater number of all the cases of stricture we meet with, a bougie above the smallest size may be passed into the bladder. These, therefore, are proper cases for the use of caustic, provided none of the above stated objections to its immediate application exist."

Most assuredly, if a surgeon were to confine the use of the caustic to those cases in which a bougie (and that not of the smallest size) will pass the stricture, he would not frequently meet with those formidable cases described by Mr. Home. But Mr. Whately is aware that the caustic is particularly demanded where a bougie will not pass, at least not without using much violence; for in a subsequent part of the volume (p. 61) he proceeds to treat of strictures imper vious to a bougie, and of the use of the alkaline caustic to them also.

We do not at all suspect any intentional misrepresentation, but many of the arguments in favour of the kali over the lunar caustic, that are given along

3 I

with the treatment of the first-mentioned kind of stricture, are not very clearly opposed to those in favour of the lunar caustic in like circumstances of disease, but rather contrasted with the severer cases. The author passes some pretty strong censure on many of Mr. Home's cases, and the persevering severity of his plan of treatment. It must be acknowledged that the application of lunar caustic upwards of a hundred times, without forcing a passage through the urethra (as in some of Mr. Home's patients), does

not speak very highly in favour of the practice; but many of this gentleman's cases exhibit a flattering success over a most obstinate disease, by an equally obstinate perseverance in this painful and dangerous remedy. The general advartage of the treatment by caustic is such as to warrant at all times a very full trial, at the same time that the severity of the lunar caustic, and its fre quent failure, fully justify, and even demand, the adoption of other applications with a similar intent.

WE insert this article simply to announce its publication, as nearly all the contents have been already before the public in one form or other, and are now collected in this volume.

It contains the translation of baron Wenzel's celebrated Treatise on the Cataract, with many and valuable notes by Mr. Ware; the author's Enquiry into the Operation of extracting the Cataract; his well-known case of recovered sight, published in the Philosophical Transactions for 1801; a counterpart to Cheselden's famous case; a Tract on the Dissipation of the Cataract, and another on the Cure of Gutta Serena, both published in the third volume of the Memoirs of the Medical Society of London.

The only additions here noticed are,

a short set of aphoristic memoranda on the various steps of the difficult operation of extracting the cataract, and three additional cases to the cure of gutta serena. In these, with the defect of sight, there was an inability to move the upper eyelid, together with some affection of the general health. They all terminated favourably, and in two of them very decided benefit was obtained, by letting blood pretty largely from the vea that runs by the side of the nose, toge ther with leeches and topical blistering. The value of all Mr. Ware's communications, on subjects connected with this branch of surgery, is too well known to require any further comment on what has already appeared before the public.

THE author announces in his preface his intention, "at some future time, to write respecting the treatment of cancer, when longer experience shall have ma

tured his practice and observations." In this he will act wisely; and, when that period arrives, we shall be happy to receive the benefit of them.

THE parts of the human body are here described in the order the most convenient for dissection, and the whole forms a very useful vade-mecum for the student of anatomy. A supplement,

containing full directions for injecting, for making anatomical preparations, and other manipulations of the dissecting room, would add much to its utility.