29 DECEMBER 1838, Page 17

MEDICAL PCIILICATIONS CONTINUED.

resume the subject of medical works with hooks of a more. learned kind, and the result of more direct labour, than any of those we disposed of last week : whilst most of them perhaps, and two ,,f them certainly, are of a higher character, and possess a greater value. They are, however. of too professional a character to permit us to do much more than describe their scope and quality.

eaorEssios AL WORKS.

1. The Principles of Surgety.

2. A Treatise on the Ear.

3. Counter-Irritation.

4. The Etements of the ;Valeria Medico.

J. 1'ruuticut and Suryie«I Anatomy.

1. Dr. BURNS'S Principles 4 Surgery is a very valuable contri- bution to surgical science, and an almost indispensable addition to the library of the young practitioner. As an exposition it is clear and comprehensive ; exhibiting in its matter the results of much experience, observation, old medical learning; and in its views a combination of boldness and caution, guided by that good sense

a which ouly is the gift of heaven, And though no science, fairly worth the seven." The subject of the Principles is twofold, discussed in two separate volumes. The first volume treats of what we may call medical surgery : not that the consideration of operations is altogether ex- cluded, but that the main points handled are the causes, symp- toms, and treatment of disease, whether spontaneous or induced by violence. The topics embraced in this section are inflammation, and its consequences, mortification, suppuration, and ulceration,— introduced by a general view of life and its various actions ; tumours ; adhesion ; haemorrhage and wounded arteries ; aneurism ; wounds ; and the management of the constitution under disease and injury. The second volume contains an account of the ana- tomy of the body, with a description of the injuries, &c. to which each part is obnoxious; the operations to bo performed for their relief, and the best modes of operating,—in which Mr.yussox's Manual (to be noticed presently) somewhat resembles this volume, except that operations are a more marked feature in Dr. BURNS; and whilst Mr. WILSON describes the mechanics of operating, Dr. BURNS also discusses the principles on which those mechanics rest. This account of the work is, however, insufficient to convey an exact idea of its nature : the student must furthermore understand, that by " principles" is meant not an account of particular dis- eases, but a theory of the origin of disease; the structures or tissues it first attacks ; the various characters it assumes ; the manner in which it spreads ; and the best mode of treating it in its various .tapes. For example, under inflammation, it is not in- flammation of the brain, or the pleura, or any particular part, which is-discussed, (although they may be introduced incidentally for the sake of proof or illustration,) but inflammation generally, in its causes, its progress, and its termination. The object of the work, therefore, is to prevent a mere mechanical and parrot-like mode of practice, by possessing the student with a large and liberal notion of the natural principles, so far as we can penetrate them, on which his profession rests : and we have no doubt, that every tyro, or even the bulk of the profession, after a careful study of Dr. Braxs's first volume, will be able to profit more by the knowledge they already have, as well as to possess themselves of a test by which they may try their future acquisitions ; especially if each, in the author's language,

. . . . 4, will critically and laboriously, and with the single desire of *trivia!, at the truth, investigate the subjects treated of, he shall by this very study, what- ever conclusion he may conic to, as to the truth of the principles contained in this and similar work's, form for himself a system of rules and doctrines, which cannot Lill to be useful."

The style of Dr. BURNS is clear, but-occasionally vitiated by Scotticisms, and with many traces of colloquial manner, as if his work (which is perhaps the case) had originally been addressed to a class. Clearness, however, is not his only merit ; he varies with his subject, and rises, when needful, to the height of his argument.

One great cause of the ridicule to which the professors of medi- cine have been exposed, is the obstinacy with which they advance and maintain doctrines opposed to fact and large experience. The origin of this error is caused by the notion, not indeed avowed, but still existing, that disease is a " fixed entity;" and (which is absurder still) that the constitutions of men are all alike, or that the same man can always be operated upon in the same way. A Medicine has been administered, and extraordinary cures have fol- lowed. The drug is immediately cried up by the practitioner and his followers, as an infallible wonder-worker. It receives an ex- tensive trial upon constitutions dissimilar to those of the first pa- tients, or whose antecedents have been different ; and totally fails. Upon which, the too exalted practice falls into unmerited disrepute, and what might have been a useful auxiliary, drops out of use ; because men, too stiff and sanguine, had wished to raise it to a principal dignity it could not sustain. To admit the ever- varying qualities of individual natures in disease, and to stand ready to minister to them without regard to pedantic rules, is one of the most essential qualities in a practitioner ; and this quality Dr. BURNS seems to aim at forming. His conclusion, as to the use of food and wine in mortification, will give a sample of him in this point of view, and furnish a specimen of his manner in purely medical topics.

" That diet which is most easily digested, and followed in a weak state by least excitement of the system, is the best in every.- instance. Whilst, therefore, I would not abstain, during any stage of this disease, from the use of weak soups and animal jellies, I would at every period have some hesitation in recommend- ing solid animal food, unless the patient expressed a strong relish for it, and bad no febrile exacerbation after it. Food ought never to begiven largely at once ; it ought to be taken more frequently than in health, and in small quan- tity, not more at a time than the stomach can easily digest. Unswayed by systems and speculations, I say that it may be given of any kind, aud to any extent which can be digested, if febrile excitement be not produced. The medicines prescribed have hoer) of a stimulating nature, such as aromatics, tinctures, and wines, o ith or without opium. 1 conceive it to be very douhtful whether aromatics and essential oils ever have done any gissl, farther than as they may, in particular instances, have acted beneficially on the stomach. But as wine is a medicine of more decided power, capable of doing both more good and inure mischief, I feel called upon to point out, as ex- plicitly as I can, those cases in which it is admissible. Under those dream- sumstances in which we have been balancing the arguments for and against blood-letting, and have determined against it, it is snrely premature to talk of giving wine. Even when we have ceased to think of the admissibility of eva- cuations, it does nut follow that wine is either required or would be as It is only when the gangrene has declared itself, when the constitution has actuallv begun to decline, that the cautious exhibition of wine is called fur. There is a turning point drhich we must not pass too far before we begin it, neither must we commence too soon. Halt a glassful of that kind moat agreeable to the patient, either alone or diluted with water, as he shall like best, may be given in the first instance. If this should produce an increase of pain or of throbbing in the part, with an exacerbation of the foyer, we have begun some- what too soon. On the contrary, if the local uneasiness be not increased; if the -pulse become rather less frequent, the heat of the skin not preternaturally increased, the general feeling more comfortable, and the action of the stomach be improved, and hiccup (if it had come on) be suspended,—if, instead of being more restless, the patient be, if not sleepy, at least tranquil, wine is doing good. The dose is to be repeated as soon as the patient feels a desire for it ; and the quantity to be altogether given in twenty-four hours must, like the administra- tion of a second dose, be regulated by the effects. If the patient become heated, fever increased, delirium produced, or the local disease accelerated under its exhibition, we are going too far. But so long as wine, on the contrary, pro- duces agreeable and beneficial effects, we are to proceed. The quantity, then, to be given in a limited time, must depend on the effect. Two glassfuls may in one ease be sufficient in twenty-four hours; in another two bottles may be taken in the same time. This, it may said, is a very vague direction ; but I. will be happy to find a better rule delivered, than, that we should be regulated entirely in the quantity of stimulus we offer by the effect of the stimulation."

We have said that Dr. Brass's two volumes are distinct in their subjects, and we rather think they have been published sepa- rately. We mention this, because a substitute for the second volume is much more easily found than fur the first.

2. Mr. FILCHER'S Treatise on the Ear is a complete and learned work ; natural in its arrangement, clear in its expositions, and sound ill its views. Dividing his subject into five sections, Mr. PM.. CHER commences with a general account of the organs of bearing ; tracing them, by means of comparative anatomy, from their simplest development in the lower animals upwards. Ile then minutely describes the anatomy of the human car; gives a brief and agreeable view of the physiology of hearing,--in which, it' the student of acoustics should find no new facts, he will receive new or fuller illustrations ; proceeds next to notice the ditlimrent malefonnations of the ear ; and lastly, investigates the diseases to which the organ is subject, with their always distressing and sometimes fatjd effects. The work is profusely illustrated by plates ; and it may be recommended as a treatise elaborate without tediousness, and sufficient in its details without being uselessly minute.

The strictly scientific character of its medical parts, and the subtile nature of every thing relating to acoustics, forbids our quoting from the treatise at any length ; but we will take a short passage for the hint it affords to parents, and the light it throws upon a point touched upon in our last week's notice of Dr. Roweasn's Neuralgia—how small a thing affects the nerve. In the following passage, we see loss of function, though no struc- tural defect could be discovered.

" The majority of instances in which the organs of hearing of sourfl-mutts have been examined, have not presented vitiations of form which would account fir the loss of function. Of the five cases published by Mr. Cock, although they all furnished evident and well-marked traces of scrofulous disease, yet two only presented malefisrmations, which that excellent anatomist could consider as cognate. and us the cause of the ileafoess. Although the cause of conge- nital cophosis [deafness] may remain concealed, it is unphilosophical to de- clare, with some florists, that the affection does not result from defective for- mation, and that therefbre it is fruitless even to attempt its investigation with the view of applying remedies : it is now well understood that there exist minute changes in the anatomical arrangement of particles, which the investi- gator has not as yet the menus of unfolding, but which may vet be incompa- tible with the perfinmance of the function of the organ. This observation being peculiarly applicable to the nervous system, it may occur that some deficwiwy may exist in the tympanic plexus of neives, sufficient to interfere. with the mechanical operations of the organ; or in the sensory nerve, capable of preventing its vital functions; both of which may elude the most careful searching. preventing besides the treat difficulty, nay impossibility, of fixing the scat of maleformatiou, when it is out of view or beyond exploration, it must he recollected. that as the imperfection of audition is often occasioned by a cause not to be detected even when the organ is laid open to our sight, so it may be expected that the greater number of cases of deaf-dumbness will remain incurable. " As might have been anticipated from what has preceded regardims the in:deformations, the degree of deafness varies. In few instances is it af‘first quite complete; but as the infant is incapable of the mental attention neces- sary to catch the slight influence conveyed to its immature mind, aud as the sounds ordinarily falling upon its imperfect ear are insufficient to produce an effect, the labyrinth, and the auditory nerve in particular, become less and less capable of being called into action; and thus in a short time, perhaps even before the defect is recognized, the function is diminished, almost to entire deafness. It becomes, therefore, absolutely requisite that the very first indica- tions of deficient audition should excite alarm, and consequently attention to its causes and treatment on the part of the parents and practitioner."

3. Counter-Irritatian. by Dr. Gesxvier.e. If a person has an inward pain, and successfully applies an irritating substance exter- nally over the scat of it, he is cured by eoanter-irritation. The use of this remedy is old, very extensive, and even popularly well known, from cautery, blisters, mustard poultices, and irritating ointments or solutions, clown to raw onions and salt for chilblains. The novelty in Dr. GaAevisee's book is not, therefore, any prin- ciple of treatment, but a new preparation, and, according to his own statement, a wonderfully successful use of it in a great variety of disorders, with more speed and efficacy and less risk than with other irritating applications. The basis of this panacea scents to be am- monia, mixed with "other stimulating and evaporable substances ;" but of many of them the ruttier is left in the dark, as well as kept ignorant of the timnnulas of most empirical and unprofes- sional course. The uses of the preparation or preparations (for there seem to be several) are threefold, according to Dr. GRAN- VILLE. 1. Quickness of effect ; a few minutes sufficing to complete an irritation, which could not be accomplished with a blister under several hours. 2. The power of controlling the extent of the sti- mulation, from a mere increase of circulation in the part, to serous or purulent secretion with sloughing. :3. Rapidity of operation; the pain subsiding at once, and a cure speedily following, unless in cases of consumption, and its analogous disorders, where longer time is required. The diseases which Dr. GRANVILLE states him-

self to have cured, are neuralgia and other nervous affections, rheumatism, lumbago, gout, paralysis, apoplexy, croup, sore throat, and many other ins which " flesh is heir to." These triumphs are narrated in one hundred cases; from which every one will draw his own conclusion, bow far Nature, the collateral treatment, and the " antidynous lotions," severally or in conjunction, operated. We can only regret that Dr. GRANVILLE had not published his for- mulas for the profession, instead of this avowed appeal wl capon- dum yulgte.s.

4. Materiel Medico, in plain English, means the raw materials of' which " doctor's stuff" is composed; in other words, it relates to the nature, origin, and properties of substances used for medicines. In its most confined sense it is limited to a knowledge of the drugs recognized by the different pharmacopoeias, the effects they pro- duce in disease, and the doses proper to employ ; and it is possible enough for a pure physician to prescribe medicines, whielthe could not identify it' he were to see. In the largest sense, the science of Materia ...Niedica embraces the theory (it is but a theory) of the modus operand; of' medicines; their effects in health as well as in disease upon man and animals; their operation when differently administered,—that is, internally, by outward application, or by in- jection into the veins ; their origin,—whether gaseous, mineral, vegetable, or animal; the mode of preparing them ; their tangible and chemical properties; and lastly, their physiological and medi- cal effects. It is in this comprehensive sense that Mr. PEREIRA handles the subject in his Elements V the Materia Medic u; the first volume of which fbrms the most complete compenditnn of the subject we have seen; embracing the result of the theories and ex- periments of the first practitioners, Continental as well as English, who have devoted their attention to the science, increased and tested by the author's own experience as a lecturer and teacher. To those who wish to study this branch of medicine, the work will

be indispensable ; and very usefid to num who only care about a general view of the higher parts of it, or who would have a book of reference :old guide to con.edt iu of imperfect knowledge or of doubt. The volume is illustrated by cuts, and the authorities are given; so that it answers the purpose of a medical bibliegraphy. The work will be compkted in two volumes.

As in the ease of Mr. Ihsettrat's Trea tise. popular extract is not easy, but we will give a sample of

DOCTORS ON DIMG=.

" &VOA physicians (as Dr. John Murray and Dr. A. T. 'Thompson) consider opium to be print:1111y stimulant ; sonic (a. Dr. Cullen and Bari L r) rtgnr.i. it as sedative ; one (Mayer) RS both—viz. a stimulant lo the Ilene- and circulatory system, but a sedative to the muscles and Allgestive ore-acs; allotho (Orfila) as neither ; while others (as Muller) call it alterative. " Again, mercury is be several writers (as Drs. Cullen, Chapman, Your g. and Eberle) placed in the :doss of sialog.:gues (can-ing saliva); by many (as 1)r. A. T. Thompson, MM. Edwards and Vava-sear. and 'MM. Tro4.e:11 and Pidoux) among excitants; by sonic. (as Conradi. Bertele, and Horn (it is c‘m- 6idered to be sedative; by one (Dr. Wilson Philip) to lie stimulant in small doses, and sedative in large ones ; by some (as Dr. John Murray ) it is placed among tomes; by another 0-(1,0 among the resoice rtia oltero,o;o 7■:,- one (Sundelin) among the liquctileients; by the tt:llowers of Broussais (a, lit gin) among revulsives; by the Italians (as (:iaconlini) among contra-stimulams or hypostheoics ; by others (as Barbier) among the ;neert:.

These difference: are a sample of the stiffness and rigidity in theory, we have already alluded to, as characteristic of doctors. It is highly probable that all these conclusions have been deduced from observation ; but from an observation too narrow and limited. Let a strong, healthy man, with a tit of the bile, take a dose of calomel ; give a nervous person halt' the quantity ; and. listen- ing to their accounts of the effects, it would scent as if they had swallowed two opposite sub:tatic.

5. Mr. WasosN's Practiced and Sargktd Anatomy appears in- tended as a guide to the young student, in class or private dissec- tions; and it is well adapted to answer its end. After a general introduction descriptive of the body and its structures, the " sub- ject" is divided into sections most convenient for dissection, begin- ning with the " lower extremity :" and the student is taught the different parts in the order in which he himself' should reach them. Besides the directions for dissecting, which are so interwoven with the descriptions as to be essentially part and parcel of them, Mr. WrLsox pauses over those parts which are the most usually ope- rated upon in surgery, and explains the mode of operation. The descriptions of the text are illustrated by fifty wood-engravings ; and the little book altogether forms a capital sank-mecum for the anatomical student.