ART. III.-1. The Principles of Surgery. By JAMES MILLER, F.R.S.E., F.R.C.S.E., Surgeon in Ordinary to the Queen for Scotland; Surgeon in Ordinary to his Royal Highness Prince Albert for Scotland; Professor of Surgery in the University of Edinburgh; Senior Surgeon to the Royal Infirmary, &c. &c. Second Edition. Illustrated by Two Hundred and Thirtyeight Engravings on Wood. Edinburgh, 1850. 8vo, pp. 803. 2. The Surgeon's Vade Mecum. By ROBERT DRUITT, Fellow of the Royal College of Surgeons. Fifth Edition, much Improved, and Illustrated with One Hundred and Seventy-five highly finished Wood Engravings. London, 1851. 12mo, pp. 660.

3. Operative Surgery. By FREDERIC C. SKEY, F.R.S. London, 1850. 8vo, pp. 709.

Or these three Treatises on Surgery the last alone is new, and not previously noticed in the pages of this Journal. The two first are new editions of works already brought under consideration. Of these, therefore, it is unnecessary to say much.

The Principles of Surgery, by Mr James Miller, are a greatly enlarged edition of the first issue of that performance, which арpeared in 1844. The work was mentioned in volume sixty-third of this Journal, Jan. 1845, as one which contained much information on the anatomico-pathological characters and history of those forms of disease which the surgeon has occasion to treat. It is only just to say, that in this respect the character of the work is at once maintained, and, it may be said, elevated, by very ample additions, especially on the microscopical anatomy of the morbid structures. To render the descriptions more intelligible, many representations, illustrating morbid structures, as revealed by the microscope, are introduced. In short, this Treatise is one of great value in the pathological department of surgical diseases, and cannot fail to prove eminently serviceable to the student and practitioner of Surgery.

Subjoined to the volume is a discourse or essay, being, as is stated, the substance of three lectures delivered by Mr Miller on the uses and advantages of chloroform in the performance of painful surgical operations, on the safest mode of application, and on the means of obviating unfavourable accidents. This discourse will be studied with interest by those who wish to employ this agent.

In the fifty-sixth volume of this Journal, October 1841, the second edition of the Manual of Mr Druitt was introduced to surgical readers as an acceptable guide to the student in surgery. It affords us pleasure to observe, that the character of the work then given has been so far confirmed, that two editions have since that time been exhausted; and this is the fifth edition of the manual. Though part of this result may probably be ascribed to the portable and condensed form of the volume, it must be allowed that a good deal belongs to the merits of its contents, and to the skill with which these contents are collected and arranged.

The work consists of five parts, which are arranged in a very simple manner.

The first part is devoted to the explanation and history of those morbid states of the system which are induced either by the infliction of injury or the advent and ravages of disease. Such are the state of Prostration or Collapse; Prostration with Excitement, and Delirium Tremens; the several forms of Fever; Tetanus or Locked Jaw, and Convulsions.

In the second part the author treats of the Elementary Processes of Local Disease in fourteen successive chapters.

These elementary morbid processes are, I. Malformation, Hypertrophy, Atrophy, and other degenerations of Tissue; II. Disorders in the Distribution of the Blood, and Nervous Pain; III. The General Phenomena of Inflammation; IV. Acute Inflammation; V. Chronic Inflammation; VI. Effusion of Serum and Edema; VII. Hemorrhage; VIII. Adhesive Inflammation and its effects; IX. Suppuration and Abscess; X. Erysipelas and Diffuse Inflammation of the Cellular Tissue; XI. Ulceration; XII. Mortification; XIII. Scrofula; and XIV. Malignant Diseases, or the Heterologous Growths.

In the third part the author treats of the different species of injuries; including the various forms and kinds of wounds; the effects of extreme heat and cold; the effects of mineral and vegetable irritants; the effects of the poison of healthy animals; the effects of septic poisons, especially those derived from dead animal bodies; the effects of poisons generated in diseased animals, as hydrophobia and glanders; and, lastly, the venereal disease.

The fourth part of the work is devoted to the history of the injuries and diseases of the several tissues, organs, and regions of the human body. The order in which the author treats of these subjects is at first very much that of works on general anatomy; and afterwards that according to the regions of the head, neck, chest, abdomen, and the extremities. This being the most important part of the volume, is treated with amplitude, and in detail commensurate therewith. In it the author naturally considers the whole of those local diseases and injuries, the manageVOL. LXXV. No. 186.

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ment of which falls under the care of the surgeon, and require to be treated either by means of local remedies and manipulation, not excluding the use of general remedies, or by means of operation properly so called.

In the fifth and last part of the volume, the author explains the nature and object of operations, the best methods of performing them; and concludes with an account of the effects and uses of chloroform, and the mode of administration, and the use of some other anæsthetic agents, during the performance of operations.

The volume is concluded with an appendix containing for mulæ for the preparation of such medicines and medicinal compounds as the experience of the best surgeons has found most beneficial in the treatment of surgical diseases.

This work strongly recommends itself to the student and practical surgeon by the large amount of matter which it contains in small compass, by the practical and judicious character of its information, and by clearness and accuracy of its descriptive details.

The work by Mr Skey is confined to the subject of operative

surgery.

It is almost superfluous to say how much reproach has been cast upon mere operative surgery by one class of medical persons, and how far even the testimony of various eminent surgeons, who have grown aged in the profession, tends to confirm this reproach. John Hunter, we believe it was, who said, that to perform an operation was an acknowledgment of the inadequacy and incompetency of his art; and the same sentiment, if not as to all, at least as to many operations, was more than once repeated by John Aber nethy.

It has been indeed asserted that Mr Abernethy was not a very dexterous or neat operator; and that this was one reason why he took occasion to depreciate operations in general. This reason, however, if it had a real existence, is not adequate to account for the effect. Any man, with average use of his hands, correct knowledge of anatomy, and pretty constant practice, may become an expert, and even, if the term be admitted, an elegant operator. A better and a more natural reason is found in the fact, that Mr Abernethy, by his knowledge of physiology and pathology, with a considerable proportion of common sense, found that he cured, by mere medical management, without operation, many local diseases and injuries, which it was the custom to hand over to the knife. Mr Abernethy was a medical and physiological surgeon; and his habits of thinking and observing led him to consider on all occasions, whether operations might not be dispensed with, and what means ought to be adopted, to accomplish this object. The

proof of the correctness of his views is furnished by the history of surgery and surgical operations during the last thirty-five years.

We have had occasion, not long back, to advert to the decided aversion to frequent operations, and to operations in circumstances formerly believed to demand their performance, evinced by two eminent surgeons of most ample experience, undeniable dexterity, and undoubted judgment. All these circumstances must be allowed to be indications that the habit of performing operations had been carried to an unnecessary and perhaps an unjustifiable extreme; that often they must have been performed in circumstances in which they were either unnecessary or positively hurtful; and that it is a proof of greater knowledge in a surgeon, to cure the diseases for which his advice is solicited, by the judicious employment of general and local remedies, than by attempting to remove the parts affected by the knife.

Of several of these objections, it is manifest that Mr Skey is quite aware; of the reproach brought by them upon mere operative surgery, it is manifest he is fully conscious; and to obviate the former and efface the latter, he feels it requisite to make a sort of apologetical defence, apparently as one reason for publishing a new work upon operative surgery.

The knowledge of principles, Mr Skey remarks, greatly exceeds in value that of the details of practice; because principles form the rule of conduct, and the practice the deduction; and, consequently, a perfect knowledge of the reasons why operation is required, and of the kind of operation which the circumstances of the case demand, ought to be the main spring to regulate the conduct of the surgeon, in undertaking even the most ordinary forms of operation. In no department of professional duty are the rules of conduct so imperative as in that, which involves the question of the removal of a portion of the body or the exposition of its internal structure by the agency of instruments; because the effect of local violence is always felt as a blow to the integrity of the frame, however ably the operation may be performed, and however pain may be alleviated by the employment of anaesthetic agents.

The truth of these arguments is doubtless self-evident. The great reasons, nevertheless, in favour of the necessity of operations are furnished by the fact, that there are certain forms of disease, which cannot be prevented, without the interference of operation, from exerting on the frame most injurious influence. In these circumstances, the proper and seasonable use of operation, carefully excluding its abuse, becomes a matter of prudence, if not of necessity, and forms a positive benefit. Considering the matter more attentively, it is known that though many limbs containing diseased bones and joints have been needlessly removed, and that there is every reason to believe, that under more skilful and patient employment of remedies, not only local but general, several

of these limbs might have been saved, yet, it is not in the present state of science that we can replace a strangulated bowel without operation, or extract a stone from the bladder without instrumental agency. Often in laryngeal inflammation and oedema of the glottis, the careful performance of tracheotomy may save life, which without that interposition would be suddenly extinguished. These, therefore, are instances in which operation may be resorted to and defended.

There is further a class of operations in which little or no blood is shed, and in which anatomical knowledge and surgical expertness are often of the most essential service. A bone is dislocated; and the limb becomes immovable, useless, and every attempt at movement is attended with great suffering. An expert surgeon reduces the displaced bone, and the patient is once more a free agent. The bladder is distended, and the patient, from some temporary obstruction in the urethra or neck of the bladder, is afflicted by agonizing suffering. The surgeon introduces the catheter, and in a few minutes delivers the patient from his affliction. In such cases as these the beneficial results of surgical interposition are manifest.

Conversely, it is now known that all those forms of disease called by the pathologist heterologous, and by the surgeon malignant, as carcinoma, enkephaloid tumours, and similar growths, though in situations admitting of being removed by operation, are not thereby cured or eradicated from the system. All of these return after intervals, variable in length from a few months to two or three years. In all cases of this class, therefore, operation is not simply useless; it is often indirectly hurtful. To this class of cases, therefore, and they are not few, operation is totally inapplicable.

The considerations now submitted constitute, in our opinion, the best and most forcible reasons for writing, not only a book on operative surgery, but a book on principles something different from those commonly recognised. If certain operations be necessary and practicable; if other operations be unnecessary and ineligible; and if another class of operations, though practicable, be useless and unavailing, in short, inadmissible,-then it becomes necessary to have a work in which all these circumstances, and all others arising out of the question, of the propriety and the eligibility or ineligibility of operation, be deliberately considered and judiciously resolved. In short, so long as the human race are liable not only to local diseases, but to injuries and their effects, some form and degree of operative surgery must be required; and all that sensible persons, not influenced by extreme opinions, can wish for, is, that they be reduced to the smallest possible number-that they be used, not abused, and resorted to only in those cases in which it is clear that they are indicated as beneficial and finally salutary.