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disease; 6n the contrary, it is often thecause of aggravation. Pain, for instance,is a symptom of most diseases ; yet itdoes not at all times admit of relief byopium, or other narcotics. Pai7i is oftenthe result of active inflammation; and,generally speaking, in such cases, opiumBlould be highly objectionable. The sameobjection applies. to want of sleep, occa-sioned by active inflammation, especiallyof the brain. If opium be given in suchcases, !nerdy to procure sleep, we mayinjure the patient, by aggravating thedisease. Increased discharges, again, arenot to be considered as diseases, but onlyas the effect of disease. The names

catarrh, and diarrhœa, and some others,would lead one to suppose, that the in-creased discharge was the real disease.If this were the case, we ought to sup-press it as quickly as possible; but thisis in opposition to experience. Such dis-charges are the result of inflammation oithe mucous membrane; it is to this, there-fore, that we should direct our attention,.nd not merely to the suppression of thedischarge. Superficial practitioners con.tinually fall into this error, they are caughtby the most obvious symptoms, and ne-glect further inquiry. If the patientcomplain of pain, they endeavour to re-lieve it by opium. If there be want of

appetite, sickness, &c., they indulge himin the use of stimulants. In chronic in-flammation of the liver, the patient fre-quently complains only of a want of ap-petite, and that the food he takes doesnot sit well on his stomach, but occasionsflatulency, and sometimes spasmodic pains.In such cases, a practitioner is very aptto be misled. He thinks of nothingmore than how to relieve these dys-peptic symptoms, by tonics and stimulants,which, in the end, generally aggravatethe disease. I allude particularly to thisease, because I have often seen slichsymptoms mistaken for the disease, andvery improper treatment resorted to inconsequence. Whole volumes have beenthus written upon dyspepsia, without anyreference to the diseased state of theorgan itself:I In my next lecture, gentlemen, I shallmake a few remarks upon the names ofdiseases. I -,hall show you that medicalnomenclature is very imperfect, and aptto mislead ; instead of giving information,as it ought to do, of the real nature of thedisease.

LECTURESON SOME

PRACTICAL POINTS OF SURGERY

DELIVERED TO THE

Students of the late Borough Dispensar,BY MR. ALCOCK.

LECTURE VII.

On Bandages.Gentlemen,

’ THE duties of surgery are of two kinds,the higher, which relate to the performanceof operations by the knife,-the ordi-nary, which comprise the treatment ofthe accidents and diseases which fromtheir frequency form the greater part ofsurgical practice. ’these common andhumble duties of the profession, thoughtoo often neglected and despised, are notonly more useful to patients afflicted withdisease, but are more nearly allied togood sense, sound judgment, and huma-nity, than " a passion for bloody opera-tions and extraordinary cures."The adaptation of bandages forms a

very important part of the ordinary dutiesof the surgeon, and on his intelligenceand dexterity in the use of the bandagehis success in practice will materially de-pend. Let it not be supposed, in speak-ing of the adaptation and use of banda-ges, that the mere mechanical applicationis all that is required : that soundness ofjudgment which is necessary in the higherdepartment of surgery, is equally so’ toenable the practitioner to determine inwhat cases the bandage may be beneficial,as well as to adapt the use of it to the ex-igencies of each particular case.The remark of Mr. Benjamin Bell res

peetiug the simple operation of blood-letting, may be equally applicable to

bandages ; for it is much more commonto see the greater operations in surgeryskilfully performed than to witness the

ueat and efficient application of a ban-dage.: The uses of the bandage are various,namely, to retain dressings, in the treat-ment of wounds, ulcers, &c. ; to retaindivided parts in contact; to compressblood vessels and restrain haemorrhage ;to suppoit weak parts; to promote thehealing of ulcers ; to promote absorption,or rather to limit deposition ; to destroypreternatural growths; to repress ini’am-mntion; and to support the parts and

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apparatus, in the treatmcnt of fractures,&c.

The appellations used by the older au-thors were as various as the differentpurposes tor which the bandages were

used ; but only serve to show the folly otdistinctions which have no foundation inusefulness.The materials of which bandages are

generally composed are linen and calico ;sometimes flannel, leather, or strips ofadhesive plaster are substituted.The forms of bandages are, the split

cloth, used for wounds or dressings on thehead or face ; the T bandage for the bo-dy; the simple roller; the double-headedroller ; these latter, the simple and thedouble-headed roller, may be used to al-most every part of the body; the manytailed bandage is chicly used in the treat-ment of fractures; suspensories, slings,&’n. may on some occasions supersede theuse of the other forms of bandage.The principles which relate to band-

ages, arc, iu the treatment of wounds,to support the dmidcd su) faces in contactaud to restrain hæmorrhage; in tileers,varicose veins, tumours, &c. to supportthe vessels weakened by disease, and toprevent inflammation and excessive de-unsition. I

mutate diseases,) and the moo beneficialeffects of diminishing the swellings andenlargements which have been producedby disease, more directly to the com.

pression of the bloodvessels, which dimi-nishes the quantity of blood circulatingwithin them, without reference to anyother power, supposing the absorption tocontinue at its usual rate. The more youinvestigate this subject the more demon.

strable it will appear. The pathology ofthat swelling of the lower extremitysometimes occurring after childbirth,termed phlegmasia dolens, has shown thatthe return of the blood has been ob.structed in the vein, whilst the obstructionnot extending to the artery, the blood hascontinued to be propelled into the limb,and the more fluid or serous portion of itforced into the surrounding parts, parti.cularly the cellular structure. Nowthitswelling before the actual obstruction tcthe circulation of the blood was detnon.strated, and Dr. D. D. Davis has the me-rit of having been the first, in this countryat least, to publish the knowledge of thisinteresting fact; this swelling, I repeat,,had long been -considered as a disease!of the absorbent system, and many inge.,nious hypotheses had been framed to ex.,plain it ; but their fallacy became obvious

1 believe that much mischief has beendone by the misapplication of bandagesto diseased parts, with a view " to stimu-late the absorbents," without that attentionto support the lower part of the limb, whichis essential to the patient’s safety. It haslint been proved that we possess any di-rect power or control over the absorbents;whilst the power ot limiting or controllingdeposition is evtdcttt and demonstrable.You are no doubt aware that every partof the Jibing body (except the hair, nails,and teciii) is undergoing perpetualchange, differing in degree according tothe various textores, but extending evento the solid parts, as may be proved evenin the bones. Now to effect this changetwo opposite ffinctions are necessary, theone the bringing or deposition of newmatter, the other the removing or takingaway that which has become useless; thetatter of these tone) tons is termed ab-sorption; now so long as the depositionand absorption are edual to each other,the part, although undergoing continualchange, will neither increase nor dimi-nish ; but if the deposition exceed the

absorption, accumulation must result,and if the absorption exceed the depo-sition of new material, diminution or

wasting of the part must ensue. Hence,therefore, we may trace the wasting oflimbs under the use of bandages, (oftenemployed 1 y beggars and others who si.

when demonstration a6brded the light oftruth.

In the treatment of simple fractures,the principles to be carried into effect bybandage’, are to keep the limb steady,,and to support the parts in easy apposi.tion. In compound fracture, the samegeneral principles, with the further at-tention to restrain hæmorrhage in thefirst instance, and subsequently to snp.port and close the sinuses which so fre-quently take place.There is one principle capable of uni-

versal application in surgery, and itwould be well if it were borne in mindand acted upon, namely, that the meansemployed in surgical treatment, and indeedin all treatment of disease, be productiveof ,

the least possible inconvenience consistently ’,with the welfare of the patient, and be de-signed and adapted to afford him the ut-most advantages which art and science canyield. Hence, in reference to bandages,if a point, as a wounded artery, be re-quired to be compressed, the principalpressure should be on that point, but

carefully guarded and graduated, so asto avoid injury : if, on the other hand, alarge surface, or a limb, require support,that support should be equable, or gra-duated in intensity, according to the na-ture of the case and the intentions to befulfilled, taking care that no undue orpartial tightness prevent the return of

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blood, otherwise the limb may becomeBtranguiated. Errors in this respect areunfortunately too frequent, and are notonty dangerous, but have bcen known to

prove fatal.A few general directions may be of

service, not to supersede, but merely assubservient to demonstration, for it wouldbe much easier to demonstrate the appli-cation of bandages to every part of thebody, than to convey any adequate prac-tical instruction by description only.Before beginning to apply the roller,

see that your preparatory arrangementsbe complete. The situation of the patientand surgeon should afford facility of ap-plication, and be in a convenient light.The roller is more conveniently unfoldedwhen held between the finger and thumb,placed at each end of the cylinder, ra-ther than by grasping the circumference.The roller should be smoothly laid upon

the part as it is unfolded, with the re-quired degree of pressure, and shouldnot be dragged atong to make it tigliter.

pose that the former was of trivial import.Let us suppose a company of recruitsabout to be trained as riflemen, and thattheir instruction were to consist in coursesof lectures in which the lecturcr mightshoot at a mark by way of illustration;but that the practice of the exercise shouldbe left to chance, or confined tothefcw,whocoulcl atford to load with guineas Insteadof bullets, and that when they had attend-ed a sufficient number of lectures, andwalked the shooting grounds, and paidsffil’it’nt fees, they shuutd be examined.Yes, examined ! but how ? not by publiclyfiring at a target, by which their titnessmight be proved or disproved, but by aprivate verbal description of the shootingat a mark, which might be as well gonethrough by a short sighted individual, whocould not even see a target at twentyyards distance, as by him who, by diligentobservation and practice, should havequalified himself to strike the mark at onehundred yards with almost unerring cer-tainty ! Could common sense endure

The passing- of the roller from one handto the other should be practised till itcan be done neatly and quickly. It is a

great awkwardness to let the roller slipfrom your hand, as it unfolds itself indescending, and cannot be convenientlyused till again rolled np into the cylindri-cal form.In applying a bandage, accustom your-

selves to make the successive folds or

turns, and the half turns or reverses,when the bandage cannot be otherwisekept smooth, with neatness and precision.Avoid unequal compression, when the

general support of the limb is designed.In the treatment of fractures, unstea-

diness should be carefully avoided. Somesurgeons make it a rule to wet the ban-

dage ; I believe it is seldom necessary.I.et the degree of tightness, or rather oflupport, be adapted to the circumstancesof each particular case. Avoid fasteningor pinning the end of the bandage overthe sore or wound. The position afterthe bandage is applied, and the mode of

such a farce ?The limit of a lecture will scarcely ad-

mit of demonstrative illustration of morethan a very small part of the instructionwhich every surgical student should pos-sess relating to bandages ; for, to be use-ful, not only is careful and patient demon-stration required, but frequent repetition,until each step be perfectly comprehend-ed and rendered familiar; for if morethan this be attempted, it must necessarilybe proportionably defective. Were it theobject of any one to display dexterity, itwould merely be requisite for him to ap-ply the bandage neatly and rapidly to thevarious parts of the body, and leave hisobservers to imitate him if they could :-but, Gentlemen, I have no extraordinarypretensions; all that I can do, every faith-ful student in surgery should be able toperform, before entering upon the actualand arduous duties of his profession :-every faithful studeutmay certainly attaina degree of dexterity and precision, andconsequently of usefulness, rarely to be

removing it are not unworthy of attention.Dexterity cannot be obtained otherwisethan by careful observation, and diligentand frequent practice ; models may serveas substitutes, but ardent fellow studentscan experience no want of living models.The advantages of the latter are too ob-vious to require comment.The absurdity of supposing that mere

lectures can teach dexterity, would not betolerated in any other art or science, andwhen we come to compare the desultoryand imperfect modes of instruction in thehealing art with the systematic trainingin the art of destroying, one might SUP4

met with even in those who have spent thegreater part of their lives in actual prac-tice ; but this high degree of usefulnessrequires that the ardent efforts of youth,should not be unprofitably squaridered,but strenuously exerted under judiciousdirection. The time I have myself mis-spent for want of such direction in earlylife, would have sufficed to acquire nearlyall the necessary attainments of the snr-geon; whilst I have had to regret, thatmany useful lessons have been forced up-on me by impressive and not tinfi-equentlyfatal errors in the practice of others

(sometimes even in cases considered so

510

trifling as to be free from danger ;) and Ihave too great a regard for truth, and toodeep a consciousness of my own imperfec-tions, to suppose, whatever may have beenmy intentions, that my own practice canhave been exempt from dangerous errors.With these feelings, Gentlemen, I wil-

lingly abandon all pretensions to appearlearned, and am content to attempt sim-ply to be useful to you, by exciting yourzeal to improve that profession, whoseobject is to diminish the sufferings ofothers:[Mr. Alcock demonstrated the applica-

tion of bandages to the head, and recom-mended the students to practise diligentlythe use of the bandage upon each other,till perfect accuracy and facility should beattained.The demonstrations consisted of the ap-

plication of the split cloth, as in dressingthe slighter wounds of the head;—of thedouble headed roller, as an uniting band-age to close wounds ; to compress arte-ries ; and to support fracture of the lowerjaw ; observing that the single or simpleroller judiciously nsed, may be made toanswer any or all of these purposes.]

REVIEW.

Medical Essays. By MARSHALL HALL,M.D. F.R.S.E,, &c. London, 1825.Svo. pp. 96. Longman and Co.

THE work contains three essays, (on theeffects of intestinal irritation ; on someeffects of loss of blood ; on exhaustion

and sinking from various causes,) the firstof which is ushered in with the followingobservations :-" There are some effects of intestinal

irritation which, although of an acute andalarming character, appear to me not tohave been always understood in practice,or discriminated from some other morbidaffections of a totally different natureand reqoiring a different if not an oppo-site mode of treatment, and of which Ihave been unable to find .any distinctaccount in medical writings.The case resembles, in many instances,

the most acute phrenitis, and it is thisform of the disorder in particular to whichI wish to draw the attention of the pro-fession. In other instances the affec-tion has assumed the character of in1lam-

mation of the intestines or peritonamm,Occasionally the seat and kind of paiuhave led to the suspicion of pleuritis; or

attacks of palpitation have suggested theidea of disease of the heart.Very frequently two or more of these

affections take their rise in succession,the first or second probably ceasing en.tirely before the subsequent one is esta.blished, an event which has, I believe,often led to an erroneous idea of themetastasis of inflammation, or other mor.bid affection from one organ to another.The occurrence of this morbid afee-

tion is by no means unfrequent. Thisconsideration, added to that of its resem-blance in different instances to inflam.mation, induces me to think that it shouldbe established and regarded, in its seve,ral forms, as a distinct class of disordersto be constantly distinguished from thelatter disease."

To illustrate his opinions, the author

has quoted the following case from oneof the journals of the day:-" CASE I.-Mrs. F., a young married

tady, had felt unwell for some days, inconsequence of slight cold. Her medicalattendant, Mr. F., had bled her copiotislythe preceding evening, apprehendingsymptoms of ente1"itis, She was ofaspMeand slender make, the mother of twochildren, generally healthy, but subject tosezrere and frequent constipation of thebowels, which seemed to form the ground.wok of her present complaint.

’

On my first visit,’ the writer observes, I found erateritis established in its rnostacute form, nor had the previous bleedingproduced any mitigation of her suSer-ings. A vein was immediately opened,and she was bled ad deliquium; the warmbath, calomel and nitre of each three

grains every fonr horrrs, and a solutionof manna in strong senna tea, (the onlylaxative that could remain on her sto-mach,) were ordered. Next day the

symptoms had remitted, bnt it was ne.

cessary to repeat the bleeding, and to

apply many leeches to the abdomen. Thebowels were now freely purged, t)nevacuations black and offensive to ade-gree I have seldom witnessed. On thethird day the mouth was sore, the abd60men free from pain, all the symptoms fa.vourable, except a quickness of the pulse,which, I thought, was attributable to theaction of the mercury : I therefore eon-signed my charge to my medical friend;but I was surprised, on the day but onesucceeding, at being requested to see

Mrs. F. again, and still more so to. findvery marked symptoms_ ef inflammation of