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ART. III. On the Treatment of Internal Aneurism by the Method of Valsalva. By THOS. BRADY, M.B., T.C.D., Fellow of the King and Queen's College of Physicians, Professor of Medical Jurisprudence, Physician to Cork-street Hospital, &c.-Dublin, 1859. pp. 21. THE object of this paper is to show that the profession have been misled by modern authors into the belief that what has been called Valsalva's treatment of internal aneurism originated with that physician. Corvisart, Pelletan, Dupuytren, and a host of other distinguished names may be quoted among French writers; Hodgson, Hope, Watson, and a similar array, suggest themselves among English authorities as having described Valsalva's method to consist in bleedings, very frequently repeated, accompanied by a gradual reduction of food to a minimum capable of sustaining life. Dr. Brady, on examining Albertini's account of Valsalva, his master's, procedure (Valsalva not having published anything himself), finds that so far from the coup sur coup system of bleeding attributed to him, not more than one or two bloodlettings were prescribed at the very onset of the treatment, and that the subsequent treatment was limited to complete rest in bed, enemata, and abstinence from wine, with so "much food and drink, weighed and measured, as would be sufficient to support life; and this not divided into two portions daily, but into three or even four, so that entering the blood vessels in small quantities it should not in the slightest degree distend them."
The author of the paper before us observes that the real method of Valsalva and Albertini was not that which has been praised as theirs by some moderns, but that those great physicians would have rejected the profuse bleeding system as dangerous and irrational. As a contribution to the history of medicine, no less than as a record of the vagaries of authors, and the blind faith with which they follow one another's statements, Dr. Brady's paper merits perusal.
ART. IV.—A Guide to the Food Collection in the South Kensington Museum. By EDWIN LANKESTER, M. D., F.R.S., Superintendent of the Animal Product and Food Collections.-London, 1859. pp. 95. Most of our readers have doubtless watched with interest the large humanitarian spirit which manifests itself in the South Kensington Museum. They will have perceived how much is being done there to bring many things that have hitherto appeared abstruse and technical within the comprehension of the masses, and that in that region at least neither science nor art any longer appears to adopt as their motto the arrogant
Odi profanum vulgus et arceo."
As an instance of the tendencies that animate the authorities of the great educational establishment to which we have alluded, we would adduce the present guide, which we receive from the pen of Dr. Lankester. As a lecturer, this gentleman has already most eloquently
discoursed, at the South Kensington Museum, during the past summer, on the subject of food and beverages, and the numbers and behaviour of the audience amply testified to the interest the subject awakened among a class of the community not professionally acquainted with these matters. The various illustrative specimens and drawings to which the lecturer drew attention, are still to be found in the museum; and it is with a view to enable the visitor to view them with an intelligent eye, that the present little work has been compiled. It is "an introduction to the general principles and plan” upon which the food collection has been arranged. Thus, after a statement of the constituents that go to form the bones, the author gives a classification of food. He establishes two great classes: I. Alimentary or necessary food; this he divides into, A. Mineral: 1, water, salt, ashes of plants and animals: B. Carbonaceous or respiratory, heatgiving; 1, starch; 2, sugar; 3, fat: C. Nitrogenous or nutritious, flesh-forming; 1, albumen; 2, fibrin; 3, casein. II. Medical or auxiliary: A. Stimulants; 1, alcohol; 2, volatile oils: B. Alteratives; 1, acids; 2, alkaloids: C. Narcotics; 1, tobacco; 2, hemp; 3, opium: D. Accessories; 1, cellulose; 2, gum; 3, gelatine.
It might be objected that this classification pledges itself too exclusively to a certain physiological theory, while it introduces more of purely medical terminology than would seem to be quite desirable. The amount of information, however, on the various subjects to which attention is drawn, is considerable, and very well put; and though there may be a difference of opinion as to theoretical questions, there can be none as to the propriety of the undertaking.
ART. V.-Epiphora, or Watery Eye: its successful Treatment by the new method of Dilatation; with Illustrative Cases. By JAMES VOSE SOLOMON, F.R.C.S. Lond., Surgeon to the Birmingham and Midland Counties Eye Infirmary, &c.-London, 1859. pp. 32. THIS is a very lucid and practical little treatise, showing clearly the advantages gained in the treatment of this troublesome affection by the operation first introduced by Mr. Bowman. Mr. Solomon's experience in this disease has been ample, as he has treated sixty-four cases by this method alone. He adduces nineteen successful cases, and describes a modification which he has introduced in the operation, and which deserves a trial, as it enables the surgeon to dispense with the services of an assistant. We can only say that, having had some experience in this disease, we are quite disposed to endorse Mr. Solomon's opinion of the superiority of the new method of treating it, and his prediction that the style will soon be altogether laid aside.
ART. VI.-The Mortality after Operations of Amputation of the Extremities, and the Causes of that Mortality. By ARTHUR Ernest SANSOM, Associate of King's College. The Prize Essay of the Medical Society of King's College, London, for the year 1858.London, 1859.
It is not often that a student of medicine ventures to lay before the
profession any literary production, and when such an event occurs critics feel bound to look leniently on the work. We should not, however, be just were we not to admit that Mr. Sansom's pamphlet stands little in need of any such indulgence; and that (putting aside a few faults of style, the signs of want of practice in authorship) this treatise would do credit to far older writers. We commend it especially to those of our readers who were interested in a controversy which Dr. Arnott originated, as to the mortality after operations before and after the introduction of chloroform. Mr. Sansom shows beyond question that the mortality has been much less since 1842 than previously. That this decrease in the rate of mortality is principally due to improved methods of treatment, and especially to the avoidance of a depressing system, and a less rigid adherence to routine, is our opinion, as it seems to be that of Mr. Sansom. Still it affords a complete contradiction to the views of those who wished to show that the mortality had risen since the introduction of chloroform. On the whole, the conclusion to which statistical evidence has brought Mr. Sansom is, that "chloroform exerts an influence favourable to the preservation of life."
The portion of the essay which treats of the causes of death after amputation, is not to our minds the most satisfactory part of it, though even here the deficiencies which we are obliged to note in Mr. Sansom's statistics are only those which are noticeable also in works of greater pretension on this subject. We allude to the absence of evidence as to that verification of the diagnosis which can only be furnished by post-mortem examination. It is our firm conviction that all these tables, founded in great measure on cases which have not been examined after death, give far too great prominence to "shock" and "exhaustion" as causes of death, and that many, if not most, of those so catalogued will be found to be cases of diseased viscera. Of this very common cause of death we see no notice in Mr. Sansom's tables, yet the practical importance of bearing it in mind and bringing it very fully before the eyes of surgeons will not be disputed. There are many useful and interesting statistical tables in this little pamphlet, besides those compiled from the records of the society above. named, and we can assure our readers that it will well repay perusal.
ART. VII.-1. Conservative Surgery. Reports in Operative Surgery. Series III. By RICHARD G. H. BUTCHER, Esq., M.R.S.A., &c.— Dublin, 1859. pp. 50.
2. Contributions to the Surgery of Diseased Joints, with special reference to the Operation of Excision. No. 1. The Knee. Illustrated with Engravings on Wood. By P. C. PRICE, Surgeon to the Great Northern Hospital, &c.-London, 1859. pp. 48.
3. On the Treatment of Anchylosis, or the Restoration of Motion in Stiff Joints. By BERNARD E. BRODHURST, &c. &c. Second Edition.-London, 1859. pp. 39.
WHATEVER may have been the case in the great world of politics, there is no question that in Surgery the most rapidly advancing party
in popular estimation is that of the Conservatives, and no more worthy representatives of the body could easily be selected than the three gentlemen whose names we have prefixed to this article. The two elder have already attained a reputation which would render our commendation impertinent, while of Mr. Price it is sufficient praise to say that of the numerous pupils who have sat at the feet of Mr. Fergusson, he is one of the most enterprising and distinguished. We need hardly state that in all questions of conservative surgery, and in that of the joints more particularly, all our preconceived opinions are in the main on the side which is espoused by the authors of these pamphlets, and of which their practice appears to have been so successful an exposition. Indeed, the results of amputation of the thigh are so discouraging, that it is no wonder that surgeons should seek a refuge from a plan of treatment which involves certain mutilation, with the most imminent risk of life; and so it was perhaps natural that the advantages of resection of the knee-joint should at first have been rather over-estimated by its supporters, as they have certainly been unduly depreciated by the favourers of the old treatment. Accordingly, it used to be asserted that the mortality after excision of the knee is far less than may be expected in amputation of the thigh, and such, if we mistake not, was the doctrine originally proposed by Mr. Butcher. Whether this is really so or not appears very doubtful from the statistics collected by Mr. Price. These give 160 cases of excision of the knee, collected from all British sources, both metropolitan and provincial, and out of these 32 died—a ratio, as Mr. Price remarks, very much the same as that given by Mr. Bryant, in a paper recently read at the Medico-Chirurgical Society, for the amputation of the thigh on account of disease at Guy's Hospital. (Vol. v. p. 43.)
Now, if we take into account the comparative rarity in country districts of pyæmia, erysipelas, and other causes of death after operations, we can hardly resist the conclusion that, had all these 160 resections been performed at a metropolitan hospital-as at Guy's, for example the mortality would have been greater than after amputation. Add that 17 of those who recovered were obliged to submit to amputation, and the resulting comparison between excision of the kuce, as it has been hitherto practised, and amputation of the thigh, is less favourable than we had supposed, even although previously disposed to suspect exaggeration in the panegyrics with which the former operation had been loaded. This however is not, to our minds, an argument for the condemnation of the operation of excision, especially in the face of cases such as that at page 6 of Mr. Butcher's pamphlet, which clearly prove its great advantages in suitable instances; but for greater care in the diagnosis and selection of those in which it is applicable. We are very happy to find that neither Mr. Butcher nor Mr. Price, although they are the warm, are not the indiscriminate advocates of this proceeding in all cases. We cannot refrain from quoting Mr. Butcher's opinion as to the excision of joints in childhood:
"It is impressed strongly upon my mind-nay, more, I would say it is my conviction, from a long and careful study of these affections, that these severer
operative measures will very seldom indeed be either warranted or called for. Repair in the young is to be looked forward to, to be depended upon as a certainty; and therefore again I repeat, no hasty removal of diseased joints in childhood." (p. 23.)
The principal object of Mr. Price's pamphlet, besides the collection of the statistics, of which we have already indicated the chief feature, is to call the attention of surgeons to the two forms in which strumous disease affects the bones-the limited and the diffused-and to enforce the doctrine, that in the limited tuberculous affection of the joint ends of the bones excision is an efficient and admirable practice; while of its application in the other form he speaks in the following strong
"I fear even the most strenuous advocates for excision of this articulation can find but little encouragement to adopt a proceeding, the ultimate result of which must in all probability prove futile to the patient, and deleterious to the cause of conservative surgery." (p. 7.)
Had this caution been present to the minds of all operators, we cannot but think that many of the unsuccessful cases in Mr. Price's list of 160 might never have figured there, and his statistics have shown a more favourable result. It is to be regretted that no clearer rules can at present be laid down for the diagnosis of the extent of bone involved; but Mr. Price's treatise will prove a valuable addition to the literature of this operation.
Mr. Brodhurst's pamphlet is a continuation or supplement of his well-known paper on the same subject in the Medico-Chirurgical Transactions, and he relates the history of several cases in which the practice of forcible extension under chloroform has succeeded in his hands in cases of partial anchylosis of the joints, with or without tenotomy. The results of his entire practice are thus given by Mr. Brodhurst:
"Of 32 cases which I have submitted to rupture (viz., of the adhesions), the following has been the result: In 11 instances complete power of motion, or nearly complete power, has been gained; in 14, partial, but useful, motion has been restored; and in 7 the limb has been rendered straight, and the joint has remained stiff." (p. 15.)
This list includes cases of soft anchylosis of all the larger joints.
ART. VIII.—A Handbook of Hospital Practice; or, an Introduction to the Practical Study of Medicine at the Bedside. By ROBERT D. LYONS, K.C.C., M.B., T.C.D., &c. &c.-London, 1859. 8vo, pp. 137.
THE object of this little work is to supply the student, during his attendance at the hospital, with a methodized plan of clinical observation, and "with brief but explicit instruction as to the best mode of procedure for investigating any given case, arriving at a diagnosis, and recording its history, symptoms, treatment, daily progress, and termination." It also embraces "a compendium of the preliminary knowledge most essential for rightly interpreting and using the information