317

embraces several important duties, and

no small share of responsibility, may, in

this country, be bought for fifty poundssterling by the greatest dunderhead that

ever disgraced a liberal and enlightenedcalling. The comforts, the health, nay, for

might we know, the lives, of the wretchedinmates of hospitals are thus bartered for

gold. Well did the poet exclaim,--" Aurisacra fames ;" for, assuredly, of all passionsthe basest and most contemptible is that of

avarice. It is evident that under a proper

system of government, the power of submit-

ting the sick-poor to experiment for the pur-pose of acquiring a pretension to superiotknowledge, would never be ceded to anyset of individuals in exchange for money.How different is the conduct pursued by the

body of intelligent men under whose admj-nistratiou are placed the Parisian hospitals .A brief account of the manner in which

"Dressers" are appointed to the latter-

named institutions may not be unacceptableto some of our readers, although to most othem the names of « Externe" and " Interne’

must be familiar.-

The " Interne" of a Parisian hospital is

chosen for four years, by concours. His

duty is pretty nearly the same as that of a" Dresser" in one of the London Hospitals ;he sees that all the ordinances of the medi-

cal officer are punctually obeyed ; attendsall cases of emergency during the absenceof the surgeon; is bound to visit the wards

which are placed under his care once everyafternoon, and to keep an exact history ofall the cases treated under his charge. The" Internes" attached to each hospital aremoreover, obliged to " be on guard," as theterm is, each for 24 hour:-, in turn; and

this provision supplies, though iiiiperfectlyywe must admit, the want of resident sur-

geons. The " Internes" are well lodgedand fed at the expense of the hospital, andreceive, each, an annual allowance of fromfour to five hundred francs.

The remarks which we made awhile ago,in reference to the appointment of surgeonsnd physicians to hospitals, apply with still

greater force to the nomination of dressers

and internes. The dresser buys his oflice-the interne wins it by merit. This fact speaksvolumes. 11’e leave the contrast which it

atlords without comment, lest we should

diminish its force by dilution.The last topic upon which we propose to

touch is one of a financial nature. The

number of patients received into the fourteencivil hospitals of Paris, during the year 1835,was, as we have before stated, 70.4M : thisis exclusive of out-patients. The expensesof these establishments, during the same

year, were about 3,000,000 of francs, or

£120,000. Thus, at the moderate expendi-ture of £120,000 sterling, no less than four-teen magnificent hospitals were supportedduring the space of one year, an immensefield was afforded for medical instruction,and the sufferings of more than 70,000human beings were alleviated. This is a

bright and pleasing picture, and shows to

what an extent humanity might be benetittedin this country were the funds of our charit-

able institutions administered by a compe-tent body of responsible individuals. How

few, even of those who devote some attentionto medical affairs, are aware of the fact,that the hospitals of Guy and St. Thomas

consume annually a sum of money nearlyequal to the annual expenditure of all theParisian hospitals put together ! A circum-stance of such importance as this cannot be

unworthy of the attention of the Legislature.

Practical Surgery ; with one hundred andtwenty Engravings on Wood. By ROBERTLISTON, Surgeon. London, J. Churchilland H. Renshaw. 1837. 8vo. pp. 494.

Practical Surgery; with one hundred andtwenty Engravings on Wood. By ROBERTLISTON, Surgeon. London, J. Churciuttand H. Renshaw. 1837. 8vo. pp. 494.

IT is by no means easy to " review," asthe technical phrase goes, a work similar incharacter and in execution, to the one whichnow lies before us. Mr. Liston should have

adopted, as a motto for his " Practical

Surgery," the celebrated saying of theCardinal Wolsey,—" Ego et rex meus;"—" Myself and my Catlin,"-for the pre-sent volume is a brief but faithful outlineof all that Mr. Liston’s mind has imaginedfor the advancement of the science of sur-

318

gery, and all that his hand has executed

during a long and brilliant practice of theart. If this renders the work peculiarlyvaluable in one point of view, it is calculat-ed to diminish its utility in another ; for theexperience of no single man can be sufli-cient to embrace all the facts which relateto the very extensive field of surgery. This

remark, however, applies rather to practicalthan to operative surgery. The latter maybe embraced, almost completely, in the ex-perience of one individual, and it is with

pleasure that we perceive that the surgeonwho, above all others, is well calculated toexecute the task, has undertaken to laybefore the profession " a plain, common-sense view of the most important injuriesand diseases which are met with in prac-tice," and of the operative means whichare most commonly employed in their treat-ment.

We fully agree with Mr. Liston in his

opinion, that the art of operating has beentoo lightly considered, and too little prac-tised on the dead body, even by many sur-geons who occupy prominent situations in

the profession. Of this, unfortunately, wehave very frequent experience in the wardsof our hospitals, where want of dexterityin the use of instruments, and, indeed, abso-lute incapacity for the performance even ofsimple operations, may be daily observed.The persons to whom Nature has thus deniedthe efficient use of their hands, afl’ect to

despise the art of operating, because theycan never hope to attain eminence by theirown performances, and therefore endeavour,either by ridicule, or the misrepresentationof facts, to diminish the importance of oneof the most useful qualifications of a siir-

geon. Accuracy of diagnosis is certainlyan essential point in the practice of surgery,and it is also necessary that what is calledthe " after treatment" of disease should bedirected in a skilful and scientific manner;but we cannot avoid thinking, that in themajority of surgical cases which require anoperation, the point of most importance isthis,--that the operation should be perform-ed rapidly and scientifically, without wasteof time, and consequent increase of suflèr-

ng to the patient, and in a way which isbest calculated to promote a speedy reco-very. It is ridiculous for the surgeon tovaunt himself on an accurate knowledge ofthe best methods of treatment after the per-

formance of any surgical operation, unlesshe be capable of executing the operationeflicieiitly. It is evident, for example, incases of urinary calculi, that unless the ex-traction of the stone be performed accordingto certain well-known rules, the after treat-ment will be of little avail. What can me.

dical care effect if the operator be unableeven to find his way into the bladder,-or ifhe divide some important vessel, and allowthe patient to bleed to death,—or if, in am-putating a limb, he do not leave sufficientsoft parts to cover the stump,-or if, incases of stricture, lie bore a hole throughthe urethra, and keep working his catheteramongst the patient’s bowels ? We do notmean to underrate the value of medical

knowledge to the operator, but we believethat the difliculties of the after treatment in

many surgical complaints are greatly in-creased by the bungling mode in which ope-rations are performed for the removal of

disease ; and we have suflicient confidencein the powers of Nature to predict, that ifsuch operations were performed at the pro-per time, and in a proper manner, the mostsimple treatment would suffice to conductthe case to a happy termination.But we have wandered a little from the

immediate subject of our article, namely,Mr. Liston’s work. The reader is not to

expect in this volume a systematic treatiseon operative surgery, in which are describedall the methods proposed or practised byEnglish aud continental surgeons, for the re-lief of accidents, or the cure of disease.Mr. Liston has judged correctly in not

swelling his book to an enormous size, bygiving descriptions of things which oughtlong since to have been banished from thepractice of surgery, or by entering deeplyinto the therapeutical part of the art. He

has, with advantage to his readers, prefer-red giving a brief but plain account of thevarious operations which he is accustomedto perform himself, and of the simple butefficacious methods of treatment which he

formerly employed at the Edinburgh Infir-mary, and still continues to practise in theUniversity College flospital, in London.The work is divided into sixteen chapters;

the first and second comprehend all matterswhich are connected with first incisions, the

opening of abscesses, the union and dress-ing of wounds, &c. Here will be foundsome plain observations, which every stu-

319

dent may comprehend, and which he will tion; but the ninth chapter, in which morbidfind, by experience, to be of a perfectly prac- gr’Ow’tlrS and enlargements are described,tical nature. Mr. Liston recommends that seems to us to be decidedly the most valu-the divided surfaces, after amputations, able and the best written of the whole. In

should not be immediately brought into this chapter Mr. Liston treats of tumours ofcontact, but that sufficient time should be the scalp; of the eyelids; the orbit; theallowed for the blood, which continues ooz- tongue and the mouth ; the autrum ; the

ing from the divided surfaces for a few lower jaw and the neck ; of erectile tumours,hours, to escape. This is a point of practice and the operations which they require; ofupon which the late Baron Dupuytren used tumours of the trunk, the shoulder, theto insist with a great deal of force. The scrotum, the patella, the lower extremity,dressings used by Mr. Liston are of the and the great toe ; of the bones and themost simple and unirritating nature, and he nerves. We regret that we can only findseems to employ frequent" water-dressings," room for the following extract, in which theas a means of alleviating extreme sensibi- difference between malignant and non-

lity, moderating the oozing of blood, and malignant tumours of the jaws are pointeddiminishing the chances of subsequent hæ- out.

morrhage. The whole of this, and of ti-ie 11 T.lie morbid groivths which involve thepreceding chapter is written 1D ’ s t’ nc ac- superior and inferior maxillary bones are,preceding chapter is written in strict ac- as might be expected, of various kinds, andcordance with the best princilrles of sur- ttieii- structure and disposition apparentlygery. There is, however, one point upon depend somewhat upon the tissue fromwhich we cannot help differing from Mr. which they have originally sprung, as theListon. At page 32, the suture is mentioned 8"’°’ membraues of the teeth, pet-iosteam of

runongst the ordinary means of adjust’rrt; the alveoli, the surface or internal structureamongst the ordinary means of of the bone, or tixe membranous lining ofand keeping together the edges of a wound their cavities. The most frightful tumoursduring the first period, and this in a manner ad’ecling these parts, which I have witness-which would lead the reader to couclude: ed, have coaimeiwed in some 4 the neigli-that Mr. Liston employs it on most ecca- bouring tissues. I have lfepentedly seen

.

’ . ’ malignant tumour of the lower jaw, to theStons after amputations. We cannot recon- 3 ttre tcr the

, , ,

’

, ., bulk of which it had so far contributed, andcile tiiis with the general simplicity of our wliielt had, on reyiewijtg its history andauthor’s practice, and with his love of urt- progress, without doubt, commenced in theirritating applications, and we think that It t-oft parts ; the upper jaw, it is well known,would have been useful had lie pointed out is involved at nn early pexiod in the malig-under what circumstances the use of tire lialit degeneration of the coitwats of the, , , , , orbit, t))’ ot the mucous linings of ths eth-interrupted suture should be applied to the moid and other cells. Very n-tany of thetreatment of wounds. tumours of the jaws are traceable to faulty

Chapters, from three to seven, inclusive, growth or position of the teeth, to disease ofcomprehend the subjects of injuries and their bodia&, or to improperly-conducteddiseases of bones and joints ; injuries df operations upon them. The tumour of the

, ,. tendons; injuries and diseases gum, epulis, is often a simple growth -of themusctes and tendons; injuries and diseases consistence of the structure from which it

of blood vessels; and injuries and diseases proceeds, and nut likely -to lie rep,ooucedof integument and cellular tissue. Theh if the exciting .ennee is removed, and the en-follow the topics of restoratiou of lost parts ; tire disease extirpated ; the eausa is decaymorbid growths and enlargements ; airrpu-

of some part of one or more teeth, of thetations; injuries and diseases of mucons . crown, tseck, or fang, or it may afise fromtattons; injuries and diseases of 111ucon1s their being crowded and displaed. Tneand serous cavities and canals ; diseast of lower jaw is the urust common situation ofthe genito-urinary organs; herHia; and, epulis; it appears in front of (,he mouth,liiially, congenital deformities and defi- occasionally at the root of the molares,ciencies. and the upper’ jaw is by no means exempt

from it.It is not our intention to follow Mr. Lis- "The tumour of the gum is of slow

ton through each of these chapters ; and growth ; it remains generally of the samewere we to reprint the o1’iginal observations tirrn consistence, and its attachments are

which they contain, we should have to ex- b"’°ad and firm ; its surface even when large, .... is covered by membrane, is unbroken, tt

tract the greater part of each chapter. The becomes lobulated unless it projects fromdissertations on diseases of the joints, and the mouth, and is exposed to injury; theon amputations, are well worthy of atten- teeth are loosened and present in various

320

parts of the tumour; around their basesome excitement may be kept up, and evensome ulceration and discharge. The tumouris not of a malignant nature in general, andeven in its advanced stages is not inclinedto contaminate the parts in its neighbour-houd; if thoroughly removed it does notreturn. A soft tumour of the gum, rapidin its progress, broken on its surface, andfurnishing fetid and bloody discharge, issometimes, it is said, met with ; there is nodanger of mistaking the one kind for theother, the remediable for the malignant;fortunately the latter is rare. I cannot recallto my recollection any case that I have seenof decidedly malignant disease springingfrom the gum.11 But, unfortunately, the maxillary antrum

is more frequently the seat of a soft, brain-like and malignant mass, than of a chroniccollection of fluid. No age or sex is exemptfrom it; and when it has fairly declareditself and has begun to appear through theparietes at any point, it is irremediable byany known means. This disease seems

sometimes to be connected with the softtumour which grows from the apex of atooth and from the investing membrane, theperiosteum of the fang. Generally, how-ever, it originates in the degeneration of themucous membrane lining the cavity, whichit rapidly fills. In the first stage, whichmay exist for some months, the cheek is

prominent and bulging; it has the samesmooth appearance as is presented by thechronic fluid-swelling, and the integumentis, for a time, as loose and free from infil-tration. The parietes are hard and unyield-ing, but a softened part may perhaps bedetected in the palate, cheek, or towardsthe tuberous process; this yields to thefinger, and affords a pulpy feel; the sameelasticity, as described in speaking of fluidtumour, is nut perceived. Some consider-able time may elapse before the tumourbursts through the parietes, and, before itdoes so, it has generally pushed its attach-ments backwards, has filled the cell of thepalate bone, has involved or contaminatedthe lining membrane of the ethmoid cells,and, perhaps, even thatlining the sphenoidalsinuses. The patient has all this time suf-fered a dull uneasy feeling in the cheek, asensation of fulness and distention. Hethen begins to find the corresponding nostrilobstructed, and, perhaps, then only appliesfor advice. The cavity will, on examina-tion, be found occupied by a soft mass, ir-regular or easily lacerable on its surface,when broken furnishing blood, and, at alltimes, a copious sanious discharge. Afterhaving burst through the parietes of thecavity in one direction its progress is rapidand uncontrollable. Portions may be re-moved by the knife, ligature, or cautery,potential or actual, but the onward courseof the tumour is continued. The teeth be-

come loosened and fall out, the tuberous

process is bulged backwards, the eye isfound protruded, in the advanced stages,npwards and forwards; soft fungous masses,sometimes bleeding profusely without ex-ternal injury, show themselves, to a frightfuland disgusting extent, in the mouth, thruat,and orbit, the features are terribly distorted,the patient becomes hectic, and dies verymiserably. In the very earliest stages ofthis disease, before there is reason to sup-pose that it has extended much backwards,it may perhaps be warrantable to attemptits entire extirpation, and thus afford thepatient the only chance of escape from socertain and miserable a termination. The

opening of the cavity and the attempt toclear it of the soft pulpy mass which occu-pies it, as formerly practised, is totally in-admissible ; it is a piece of unmeaning andutterly useless cruelty. If anything is tobe done it ought to be set about with athorough determination to go beyond thelimits of the morbid growth, to remove thecavity which holds it, and thus get quit, ifpossible, of all the tissues implicated, orwhich may have become disposed to take ona similar action. I know from experiencethat this step, if adopted in time, may provesuccessful ; but it is at least a doubtful anda very severe proceeding, not by any meansunattended with danger ; it is, however,the only remedy."

The extract which we have just givenwill enable our readers to form but an im-

perfect notion of Mr. Liston’s work. Al-

most every page abounds in matter which is

equally interesting to the surgeon, and ne-cessary to be known by the student. Everyremark has a practical tendency. This is

the distinguishing characteristic of thework -a quality by which it ;s raised ia-

finitely abov e any similar volume treating onthe same subjects in the English language.The only reproach which we feel inclinedto make to Mr. Listen, is that of his seem-

ing to underrate the difticnlties of most

operations, and the want of a sufticientlyminute descriptinll of the manual part ofeach particular step in operations. This,however, we can more readily pardon inMr. Liston than in any other surgeon ; he

naturally thinks lightly of the formidable

operations which, under his dexterous hands,are performed with the utmost rapidity andsecurity, and imagines that a process whichis so easy to himself must be understood,without etiflictalty, by all his readers. We

believe that it would have been more pru-dent to suppose the reader to be compara-

tively ignorant, and to have led him on,

321

step by step, from the first incision into theskin, to the termination of the operation.We have already expressed an opinion of

the work in terms which sufficiently indi-cate our high estimation of its value, as atreatise on practical surgery. It is now

our duty to mention a few omissions whichMr. Liston will, without donbt, rectify in asubsequent edition.The operation of amputation at the hipjoint

is mentioned only in an incidental manner. Itcertainly deserved, not only a separate anddetailed description, but an accompanyingwoodcut; and this omission is the more ex-traordinary, as the skill and dexterity of theauthor in amputations at the hipjoint, havebeen the subjects of general admiration.The chapter on the restorntion of lost partsis rather meagre; the author might certainlyhave referred to some of Professor Dieffen-bach’s processes with advantage. The treat-ment of artificial anus is barely noticed, andthe utility of the enterotome, is, we think,much underrated in the work. Mr. Liston

considers the operation of lithotrity as beinginapplicable to children. 11 The operationof lithotomy (says Mr. L.) must yet continueto be performed on children, and on those ofmature age, who arc so ill-informed, or sofoolish, as to permit the stone to attain aninordinate bulk." The numerous operations.however, performed by Leroy d’Etiolles,and Segalas, sufficiently demonstrate the

practicability of breaking np calculi in

the bladder of the child, even when the

patient is under the age of twelve months.We should not omit to notice the numer-

ous woodeutsl by which the different atnpu-tations, and various diseases, are illustrated.These cuts are abundant in number, andwell executed, and the pubjects are chosenwith discrimination. We observe that one

of them (page 168) has accidentally beeninberted upside down, and presents an

appearance which might embarrass the

young student.

As a standard work on practical surgery,the volume of Mr. Listen is admirably cal-culated to aid the student in his pursuits,and the young practitioner in the perform-ance of the daily duties of his profession. :

The illedical Pocket-Book and Almanac for1838. By JOHN Foomi;, jun. London:Rcnshaw.THIS little compendium is an improve-

ment on the digest of last year, and containsmuch useful information. Its contents willnot be burthensome to the memory, nor itssize to the pocket. It is a volume of refer-ence upon subjects that interest the medicalman, and, if it has no great pretensions asa literary work, it has some claims on thescore of its usefulness. The Almanac willbe found serviceable to those who attendthe medical and scientific societies,the even-ings and the hours of meeting being dailynoticed. The information which it containson sundry matters connected with the medi-cal institutions is intelligibly and correctlygiven, and the points of reference in theNew Pharmacopoeia, with the succinctaccount of the remedies which have beenintroduced into practice, either in this coun-try, or on the Continent, during the last year,will render the Pocket-book of service tothose who require such a monitor. A for-

mulary of useful prescriptions, of the latestdate, taken from some experienced practi-tioners, makes it useful to students.

WESTMINSTER MEDICAL SOCIETY.

Saturday, November 18, 1837.

MR. HALL THOMSON, President.MR. EVERITT ON THE PRESENCE OF ARSENIOUS

ACID IN CANDLES AND FATTY MATTER.

THIS evening was chiefly occupied by aninteresting lecture by Mr. Everitt, in whichhe detailed the means used by him for de-tecting the presence of arsenious acid in

fatty matter, and communicated the resultsof some researches he had made relative tothis subject. The lecture, which was illus-trated by many experiments, and attendedby a larger number of members and visitorsthan any meeting during the session, wasmore than usually interesting. The lec-turer said, in commencing, that for the put--pose of rendering his views and experi-ments clearer, he should divide the subjectinto three heads. The first was

The Method of detecting the presence ofArsenious Acid in Fatty Matter.

Mr. Everitt said, that, after many trials,the details of which would not interest theSociety, he was induced to recommend thefollowing means for demonstrating the exist-ence or non-existence of arsenious acid in