27 MARCH 1852, Page 18

TRAVERS JUNIOR'S OBSERVATIONS Ill SUROBEY. • THESE contributions to the science

of surgery contain the result of judicious reading and close observation, and display a sagacity without which reading and observation can do little. The general treatment of the subjects is broad and comprehensive, dealing with principles rather than particulars ; such details as are presented being calculated to illustrate either principles or the exceptions to the rule. The style is well adapted for exposition, being plain and close: it has no ornament or eloquence, or attempts at either ; but there is sometimes a distinct and striking selection of symptoms, which may be said to picture the case. The observations treat of some of the most important and in- teresting branches of surgery : fractures, chiefly of the limbs, and their consequences—injuries of the scalp and (menial surface, fol- lowed by those of the brain—local inflammation, diseases of the joints, and several disorders of the urinary organs. The treatment is not elementary, but addressed to men who are practising their profession, or to minds which regard the workmanship of Nature, the progress of surgical science, and its practice under the guidance of philosophical study, as a topic of liberal curiosity. Popular in the sense of general reading no professional work can be if it is technically worth anything ; but Mr. Travers's book is intelligible to popular surgical and medical acquirements if the reader brings with him a taste for such inquiries. While medicine, in the opinion of many, has made little real advance since the time of Hippocrates, or at least of the ancients, the progress of surgery has kept pace with the most forward physical sciences—as chemistry and geology. This progress is not wholly to be ascribed to the fact that the result of violence is gene- rally obvious daring life and in almost every case after death, and thus the surgeon not only sees the cause of 'death but of the whole previous constitutional disturbance ; whereas the physician has uently only symptoms of a masked or secondary kind to guide him, and after death can often see nothing satisfactory. This dif- ference, we say, is not the sole cause, for it always existed : the surgeon for many centuries went on amputating limbs which are now saved as a matter of course, and torturing patients with all sorts of plasters spread with infallible remedies for wounds, where nothing is now done but ,to bring the parts together, to keep them and the patient as cool and as comfortable as possible, and to leave the cure to Nature, who works best when not interrupted.. Bleeding, and all the other collateral treatment regularly adopted in olden times, is abolished in the majority of cases, and patients are less physicked by the skilful modern surgeon than many would physic themselves in a normal state. The fact is, that for this last half-century philosophy and science have been doing what literature and art have ceased to do—following Nature.

Of this school Mr. Travers junior, like his father, is a worthy pupil. He neither fanatically overrates nor as fanatically under- values authority ; for often an authority may turn out to be no authority at all, from the text having been misread or misunder- stood. But in all cases Nature is his mistress and guide. An el- ample of this may be adduced from the section on one of the most terrible diseases that afflicts humanity—stone, in connexion with lithotrity ; a mode of operation whose general utility we have doubted from its first introduction.

"The operation for the relief of stone in the male bladder has acquired a, new interest of late years from the great progress of lithotrity, which seems likely to render the old method of lithotomy a very rare occurrence, if not altogether obsolete. Having seen two cases of lithotrity terminate fatally during the last twelve months within the first fortnight next after the operation, and having remained in personal attendance, upon more than one occasion, where the parties appeared to me to suffer a great deal more during the passage of the detritus than is customary in the worst and most prolonged operations by the knife,—considering also how difficult it is to trace the after history of the results of lithotrity, the patient being usually pro- nounced well, or the practice being.. declared successful, long before it can be certainly ascertained that no more fragments exist,--it does appear to me that the superior claims and advantages of the new method are by no means established, It has been shown upon authority recent and familiar to all that there are occasions and forma of the disease which are suggestive of the employment of the lithotrite ; but with a hard atone of average di- mensions, the bladder and kidnies being sound, and the patient not being ex- hausted but suffering severely from broken rest, progressive loss of strength, and the other consequences of continued pain, it has not yet been proved that any better or safer plan of treatment can be adopted than that of cutting in perm* as first performed by the great Cheselclen now more than one hun- dred years ago."

This general opinion is followed by a detailed ease, and by allusions to other cases in support of Mr. Travers's judgment, which seem strongly to confirm the doubts we have expressed. Fog a really successful operation by lithotrity, not a mere dismissal of the patient alive, leaving him to endure pain or even agony for a longer or shorter period, and die at last, but for an actual cure, two things seem essential,—the stone should be reduced to powder, not merely broken into bits ; there should be sufficient vigour in the patient readily to expel these debris. Unless both conditions be complied with, the remedy may often prove as bad as the disease.

• Observations in Surgery. By Benjamin Travers junior, F.R.C.S., lately Resi- dent Assistant-Surgeon at St. Thomae'd Hospital, and Lecturer on Surgery, &e. &c. Published by Longman and Co.