with the intention of illustrating the common matters of practice, he now hopes that they may sometimes have the interest of novelty also; since the close observation of what are called common cases has led to new views and improvements of practice, as well as to the illustrations of the acknowledged principles of the art. Every one must be convinced that there is room for a critical inquiry into the present state of surgery, and it cannot be more safely undertaken than in the form of Observations made at the bed-side of the pa tients. "In published cases, a very common defect is too much consistency-matters proceed so smoothly, that when the young surgeon enters on the actual duties of his profession, he is troubled with adverse occurrences, for which he is quite unprepared: and he wonders to find his experience so different from what he has been led to expect from the perusal of cases. The utility of cases arises from the confessions of the surgeon which exercise the reader's mind, and enable him to anticipate the harassing difficulties of practice. Whoever proposes to publish useful cases, must have a full dependence on the candour and liberality of his readers, and forget those whỏ lie in wait for occasions of rancorous criticism. He has to draw two parallel histories-the history of symptoms, and the history of his own mind, with his doubts and anxieties during the course of the disease. Just so far as the observer's mind is active, and the communication of his thoughts free, will the cases be useful. "The author wishes to avoid that distortion which love of system produces in cases which are given in illustration of particular doctrines. He hopes to combine the interest and usefulness which arise from the perusal of cases, classed so as to enforce practical results, with the genuine and uncoloured statement which belongs to the records of an hospital. "Those who feel interested to inquire, may find security for the fulfilment of this undertaking in a life hitherto given up to the improvement of the younger members of the profession—where the labour and the pastime have been only a variation in the manner, not in the object of pursuit,—namely, the improvement of anatomy, and its application. The author now enters on subjects of higher interest and greater magnitude, as relating to questions of life and death. In judging of his motive it will perhaps be recollected, that upwards of twenty years have been given to anatomy, and to the teaching of the acknowledged principles of surgery, without aiming at improvements in practice; that before he has entered critically on matters of practice, he has waited until half a life, spent in the laborious duties of teaching, together with the possession of the fullest opportunities, may be supposed to have matured his judg ment. "He is happy in thinking, that by this undertaking, he shall prolong the term of his connexion with his pupils, and continue to afford to them, though in the country or on service, the advantages of hospital practice and an extended experience, which at a distance from the capital are not easily obtained." Twenty Twenty years and half a life are sonorous words, but, like every thing in this world, they are only comparative. The youth fresh from the shop, views the man of forty as somewhat beyond his maturity, whilst the veteran is apt to consi der him still in his boyhood. We are not now referring to Mr. Charles Bell's age, of which we know nothing; but, recollecting him as a young writer, and not over delicate in his remarks on his seniors, we acknowledge that we do not easily surmount our first impressions. This our readers will consi der as a confession, and one which we wish them to keep in mind, should we express less, satisfaction with individual parts of this work than we hope to do with the whole. The first report on Cancer contains a short account of the institution of a cancer ward by the first Mr. Whitbread, which introduces the recommendation of the plan of compression by the late Mr. Whitbread. "I have only (says Mr. Bell) to observe, that the essential part of this new plan of cure is the compression of the cancerous tumour, gently at first, and with a force gradually increased, till at last it is augmented to a very great degree: and that the means are these-if the cancer be open, the various holes and cavities are filled up from the bottom with chalk, finely levigated, and all the surface is thickly covered with hair powder; over this, long plaster straps are put, so as to cover the whole surface of the tumour, over this again are placed linen compresses, bound down with the turns of a roller, firmly applied, and of six yards in length; or over the first straps are laid a second set, bracing the parts more firmly than the first, over this a plate of lead, and lastly, the long roller is carried round the chest, compressing the whole." A Report of the Medical Committee follows; by which it appears, that eight cancers in an ulcerated state, and eight in a scirrhous state, have been submitted to this treatment; that in some cases of open cancer considerable relief was afforded, but that the specific nature of the cancer remained the same, and, that in some instances, the fatal issue was hastened. In the scirrhous stage, the benefit was still more doubtful. We copy the following penultimate paragraph, as have hereafter occasion to refer to it again. we may "Your committee, however, although they cannot lay claim to the discovery of a specific, have still the consolation to believe that they have in many cases succeeded in obtaining great alleviation of suffering; such alleviation as might, perhaps, induce some speculative minds, less disciplined by experience, to conclude, that they had at length succeeded, in discovering a cure for cancer. Some observations follow by the author. Here we expected a most minute description of those cases in which pressure had been useful, contrasted with those in which it had had proved useless, and had even done harm. From such sources of experience, and such habits of observation, we expected nothing less than instructions under what circumstances we might use pressure with safety or advantage, and such in which it would aggravate a most painful disease. If in this we expected too much, we might at least have been informed, that, after the most diligent research, the committee were not enabled to offer any instructions concerning the character of any local ulcers or tumours, in which they might expect benefit or injury from pressure. injury from pressure. Another cir cumstance will probably strike the reader, "that the committee do not lay claim to a discovery of a specific." However, as far as the remedy goes, they have the consolation-of what?--of adopting a plan, the benefit of which, Mr. Whitbread witnessed under Mr. Young, who, though not named, we conceive is sneeringly alluded to as one of those " specuting minds, less disciplined by experience.' Some remarks follow on the advantages of bandaging in sinuous ulcers, and of rest in some obstinate spreading sores. Reverting to the work recommended by Mr. Whitbread, we are told, the only successful case "is a cancerous lip;" and, in this, it is easy to prove, that THEY are anticipated in the method of curing what is called cancer of the lip." What induced Mr. Charles Bell to commence this remark by they, we know not, but, when he concludes this sentence, by assuring us that rest and pressure will" infallibly cure malignant ulcers of the lip without excision;" we cannot help wishing he had taught us how to distinguish such an ulcer from a cancer, for we believe that many of the young gentlemen to whom he addresses himself, will recollect cancerous lip, for which the operation has been imperfectly performed, and in which, after stitching, long continued pressure, and rest, the disease has returned with such increased violence as to discourage all future attempts. These events, however, show, that pressure may be useful in some cases which are not easily distinguished from cancer. This is the consolation, and by the passage above quoted, such would appear the implied " discovery of the committee,' were it not for the penultimate paragraph of the "additional observations." "And now (says Mr. Charles Bell,) it only remains for me to state, that the idea of destroying by pressure, dangerous tumours, which could not be extirpated with the knife, is familiar to me from my first entering upon the study of our profession. Mr. John Bell had an opinion, that it was possible to suffocate and subdue the action of vessels in tumours by the compress and bandage. This he was wont to illustrate by the effect of that bandaging of the limbs, by by which mendicants reduce the substance of their limbs to a third part of their natural bulk; by the example of the feet of the women of China, and other ingenious analogies. He argued, that, if the natural structure of the body could be moulded by pressure, why should not these formidable tumours?" In these remarks and extracts we have omitted to notice some theories which we hope will be hereafter explained. According to the author's observation, pressure" does not subdue specific action. Nor is it desireable; that absorption of the matter of cancer should take place. In true cancer, there is a peculiar matter unlike the original structure, produced by the specific action, and deposited in the texture of the tumour. Now were it possible, that the compress and bandages did actually excite the lymphatics to absorb the cancerous disposition," -we stop here, as we are afterwards told, "this a mere matter of opinion and speculation." Still it should be intelligible; matter and structure are two things, and ought not to be compared together. Still more difficult is it to conceive, how the lymphatics should absorb a disposition. The second report on diseases and wounds of the larynx, and of the operation of bronchotomy, contains many just suggestions, but nothing new to those who have perused some of our numbers of the last and preceding volume. We wish Mr. Bell had been more explicit in the following short paragraph. "In these four examples (says he, alluding to four preparations in the Museum) of disease of the larynx, we see the nature of the membrane of CROUP. It is formed by inflammation of the membrane lining the larynx and trachea, by which a proportion of coagulable lymph [more or less, according to the violence of the inflammatory action] is added to the mucous secretion. Accordingly, it assumes, in one instance, [No. 1], the appearance of concreted mucus; in another, [No. 4], the character of coagulable lymph." Every one knows how uncertain a sense the sight is, and particularly when applied to wet preparations, seen through two or three mediums. Though, therefore, the youths (Mr. C. B.'s hearers) might seem ready at taking their master's word, and giving him credit for his accurate discrimination between coagulated lymph and concreted mucus, yet a teacher should always remember, that the apparent acquiescence or dutiful silence of a scholar, is no proof that he is satisfied with, or even that he fully comprehends his teacher. The third report of diseased pharynx and oesophagus has some interesting and useful cases, with good practical remarks. The fourth, containing cases of fistula in perineo, is full full of histories of those complicated evils with which the urinary, genital, and neighbouring parts are so often afflicted. The fifth report is on fracture and dislocation of the spine, with injury of the spinal marrow; cases of fracture of the ribs, attended with emphysena and with caries. We copy the first case as a specimen of the mode in which young gentlemen should be admonished in lecture, and afterwards in print. 66 *I am happy to meet you again, and especially, because there is a subject on which I wish to address you: and you must excuse me for saying, that it is a subject of which you are criminally negli gent. It is easy to know whether or not a student be properly edu cated, by observing the things to which he attends in an hospital, just as you may know a gentleman of liberal pursuits by his conversation, and the objects which interest him. You will presently observe the application of this remark. "There was an old Irishman, one of my patients in the accidentward, when I left town, in whom I took much interest, and often I drew your attention to the case, and made you feel his sides. To many of you I explained his critical situation. Shall I confess I was concerned to observe the little attention that you paid to this subject? "He was a man of sixty-five years of age. He had fallen from a ladder and struck his left side upon the corner of a chair; he remained at home for three days, until his master, having called on me, procured his admission here, to which you know his misfortune gave him a title without my influence. I found him sitting up in bed, suffering much from pain in his side, aggravated by a short cough. On examining the side, it was not possible to feel the ribs, but you might perceive other evidence of his ribs being broken in the emphysematous tumour which covered them. He was fat, with that looseness of skin which is characteristic of his years; the skin was blown up, forming a tumour extending from the ilium to the clavicle. "There, was no doubt that the rib was broken, and the lungs torn. I witnessed his situation with considerable uneasiness; but, as he could lie down, and as he repeatedly affirmed he was easy, but for the troublesome cough which he said gave him pain in his side, I was satisfied with ordering him to be bled, and to have a linctus for his cough. I sent to inquire for him in the afternoon: I visited him in the evening: I sent again in the morning: and I saw him at twelve o'clock. The tumour spread further over the breast, and over the hips; but nothing untoward occurred. He continued better the third day; on the fourth, he was still better. On, the sixth and seventh day from the accident, the emphysema began to dissipate, and, by the common attention to confine the motion of the rib, and keep the circulation low, he quite recovered. NO. 226. From Clinical Lectures." 3 b "Here |