11 APRIL 1846, Page 17

BRODIE'S SURGICAL LECTURES.

IN 1831 Sir Benjamin Brodie ceased to give "a complete and systematic course" of lectures on surgery and pathology, but he occasionally ad- dressed the students of St. George's Hospital on those subjects. Some of the lectures thus delivered have been revised and corrected ; and, with two or three discourses before the College of Surgeons, and on other occasions, form the volume before us.

The origin and to some extent the general character of these Lectures are analogous to those of Sir Joshua Reynolds's Discourses. As Presi- dent of the Royal Academy, it was not Sir Joshua's function to interfere with any special subject of instruction assigned to a particular professor ; but at the annual distribution of prizes, he wished, for "his own credit, to say something more than mere words of compliment," and therefore selected some general subject of art ; and the addresses thus delivered grew, in the course of years, into the celebrated body of Discourses. The position of Sir Benjamin Brodie seems to have been somewhat analogous to that of the great founder of the British school of art, inasmuch as he was shut out from any course of special instruction and thrown upon more independent topics. His Lectures Illustrative of various Subjects in Pathology and Surgery have not, indeed, the breadth and profundity of Reynolds's Discourses; they do not exhibit such a connected view of their respective art, or form such a body of canons. Neither are they based upon such fundamental principles ; being mostly, in fact, of a very practical character. They contain, however, the results of an eminent surgeon's inquiries and experience; and, except in two introductory addresses, are rather designed for the student than the pupil—for those who have mastered the elements of their profession, and are about to put their acquirements into practice.

The Lectures are twenty-one in number, and their subjects are very various. The two opening addresses consider the studies required for the medical profession, and advise the students respecting their duties and conduct. The next lectures form two very interesting chapters on strangulation and its effects in hanging and drowning, with the proper but almost hopeless treatment. These are followed by the singular sub- ject of cysts containing watery fluid, apparently connected with the liver. In short, the volume comprises a choice of surgical and pathological questions, from such an apparently simple matter as corns and bunions, to the opprobrium of medicine, tic douloureux, or the curious and fearful subject of mortification.

The treatment of the questions displays the master. Everything is large, conclusive, easy, and simple—so simple, indeed, that the sciolist may sometimes think that superficial, which is complete by exhibiting only what is essential. The true limits and powers of art are shown; and the student is warned how much must be done by nature, how little (and very often nothing) by treatment; as, on the other hand, when nature is to be assisted or interfered with, what promptness and nicety of discrimination are required. The experience and acquirements of the writer also impart character to the lectures, by the clear, comprehensive, and easy brevity with which many things are treated. Something, too, of the " landator temporis acti" is occasionally visible in his recom- mendation of old remedies and old books or modes of practice, and in Ins allusions to the older surgeons with whom he was acquainted in his youth. The lectures are constantly interspersed with remarks which carry with them all the weight of axioms, from the evident correction which experience is offering to theoretical conclusions.

We select some extracts from those parts which possess in themselves a general interest ; leaving professional readers to consult the volume.

HOPE ALWAYS.

The first question which should present itself to you in the management of a particular case is this—Is the disease one of which the patient may recover, or is it not? There are indeed too many cases in which the .patient's condition is so manifestly hopeless, that it is impossible for yen to overlook it. Let me, however, caution you that you do not, in any instance, arrive too hastily at this conclusion. Our knowledge is not so absolute and certain as to prevent even well-informed persons being occasionally mistaken on this point. This is true especially with respect to the affections of internal organs. Individuals have been restored to heaith who were supposed to be dying of disease in the lungs or mesenteric glands. But it is also true, though to a less extent, with respect to diseases of parts which are situated externally. I know females who are now alive and well, who were supposed to labour under malignant disease of the uterus; and I could mention many eases in which patients have recovered of what had been regarded as an incurable disease of a joint It is a good rule in the practice of our art, as in the common affairs of life, for us to look on the favourable side of the question, as far as we can consistently with reason do so. A sanguine mind tempered by a good judgment is the best for a medical practitioner. Those who from physical causes or habit are of a desponding character, will sometimes abandon a patient to a speedy death, whom another would have preserved altogether, or for a consider- able time.

BE QUIET.

There is another inquiry which should be always made before you determine on the adoption of a particular method of treatment—What will happen in this case if no remedies whatever be employed? if the patient be left altogether to nature, or to the efforts of his own constitution P There are many diseases which, for the most part, undergo a spontaneous cure; and we should be always very cautious how, in such cases, we disturb the natural process. A prudent physician watches a case of measles or smallpox, but it is only on some special occasions that he ventures to have recourse to any active remedies. The surgeon ought to be in- fluenced by similar views in the management of the cases which come under his care; those, especially, in which the patient suffers from the effects of mechanical injury. The animal system is not like a clock or a steam-engine, which, being broken, you must send to the clock-maker or engineer to mend it, and which can- not be repaired otherwise. The living machine, unlike the works of human in- vention, has the power of repairing itself; it contains within itself its own engineer, who, for the most part, requires no more than some very slight assist- ance at our hands. We bring the edges of a wound into contact, but the vascular union, which constitutes the healing by the first intention, is the work of a higher art than any that we profess to practice. If this mode of union fails, and the wound is to be healed by granulations, still this is not accomplished by our means. So where there is a simple fracture, all that we can do is to place the two ends of the bones in a proper position, and keep them in it. The process by which they are made to unite, so as to be again consolidated into one bone, is not under our dominion and controL These are, it is trim, examples of slighter and simpler injury; but even in those in which the injury is more severe and complicated it is easy for us to interfere to the patient's disadvantage; and in fact it may be truly said, that there is, on the whole, more harm done by too much than there is by too little interference.

EXPERIMENTS ON DROWNDIG.

If a small animal be immersed in water in a transparent glass vessel, the pluenomena of drowning are readily observable. There is first a deep expiration, by which bubbles of air are expelled fm the lungs. There is then an effort to inspire; but the effort is ineffectualthere being no air which can be received into the lungs; and a spasm of the-niuscies seems to prevent the admission of water in any considerable quantity into the trachea. The attempts to breathe are re- peated several times; and after each attempt a small quantity of air is expelled from the month and nostrils, until the air-cells of the lungs are almost completely emptied. Then the animal becomes insensible, and convulsive actions of the muscles mark the instant when the brain begins to suffer from the influx of the dark-coloured blood. After these convulsions the animal is motionless, and gives no signs of fife; but if the hand be applied to the thorax, the pulsation of the heart, gradually becoming fainter and fainter, indicates that some remains of vitality still linger in the system. Before the circulation ceases altogether, the muscles of respiration resume their action, and some ineffectual efforts are again made to breathe. It is a remarkable circumstance that the diaphragm continues to exert itself nearly as long as the heart itself, so that the interval between the cessation of the attempts to breathe and the cessation of the motions of the heart, short as it lain animals that die of strangulation, is shorter still in those that perish from drowning. These phenomena follow each other in rapid succession, and the whole scene is closed, and the living animal is converted into a lifeless corpse, in the brief space of a few minutes. I have never opened the thorax of am animal in which the heart was found acting in such a manner as to maintain the circulation of the blood so long as five minutes after complete submersion; and from the information which I have received from some of the medical attendants at the receiving-houses of the Royal Humane Society, I am led to believe that the period is very rarely, if ever, longer than this in the human abject.

LADIES' snow.

If shoes were constructed of the shape of the human foot, neither too large nor too small, and making an equal pressure everywhere, corns and bunions of the feet would never exist. But, unfortunately, shoes are seldom made after this fashion; and in ladies' shoes especially there are generally two signal defects,—first, the extremity of the shoe is much too narrow for that part of the foot, (namely, the toes,) which it is to contain; and, secondly, for the purpose of displaying as much of the foot as possible, the whole of the tarsus and metatarsus is left uncovered, and the pressure of the shoe in front is thrown entirely upon the toes. The toes are thus first squeezed against each other, and then pushed out of their natural position; and all the projecting points, chiefly where the joints are situated, are pinched and tormented either by the neighbouring toes or by the leather of the shoe; and thus it is that corns of the feet are generated.

A SINGULAR CASE OF MORTIFICATION.

Whenever putrid matter is pent up round a slough of the cellular membrane, the system is poisoned by it. The snlphureted and carbnreted hydrogen gas evolved during the decomposition of dead animal matter seem to pass, in part at least, into the circulation, producing the most dangerous symptom. The incisions which relieve the tension of the skin allow these noxious gases to escape, and the relief which this affords to the patient is very remarkable. I might, if it were necessary, enumerate a great number of cases in illustration of what I have just observed. One, however, will be sufficiecit; and this I am tempted to relate, be- cause the case is in itself of great interest, and also because a particular instance nuty serve to impress the rule more on your minds than a more general obser- vation. I was called, some few years since, to see a gentleman, who appeared to be actually on the point of death. His extremities were cold; his pulse barely perceptible. It was doubtful whether he was sensible or not. He made, on being roused several imperfect attempts to speak, but could say nothing intelligible. Below the right hypochondrium there was a considerable tumour, the akin being of a dark red colour, on the verge of mortification. On examination with the fingers, I perceived a sort of emphysematous crackling, and an imperfect fluctuation. Having made a free incision, I discovered, underneath the dis- coloured skin, what might be called a quagmire of slough. A small quantity of putrid matter escaped; but there escaped also such a quantity of noisome and offensive gm, apparently sulphureted hydrogen, that I could scarcely bear to re- main in the room. The stench e pervaded the whole house, and even could be per- ceived in the garden round it. Within two minutes after the performance of this operation, so trifling in appearance, but so important in reality, the patient looked up, and said, quite distinctly, "What is that you have done which has made so great a difference in my feelings?" At the same time the pulse returned at the wrist; and from this moment he recovered, without any further unfavourable symptoms.