less, and it is a frequent occurrence to notice in the newspapers that a county jail is without a single tenant. Alienations of property from families, whose heads had become drunkards, have lessened in a very remarkable manner in almost every town; the use of wine is diminished among the rich, and instead of the strong Spanish wines, the light wines of France and Germany are getting into general use. In consequence of this the chronic affection of the stomach, commonly called dyspepsia, which was very prevalent, has almost disappeared, and gout is scarcely heard of.

The disuse of ardent spirits in the northern states is believed to have increased the physical power of this section at least one-sixth, so that if we allow for its population about 5,000,000, the force of a million of persons will have been added, while the expense of supporting the 5,000,000, instead of being increased, has diminished by the appropriation of that grain for nutrition which was employed for distillation.

The public sentiment is so strongly in favour of prosecuting the temperance reform, that it called on the legislature of Massachusetts to prohibit the sale of ardent spirits on Sundays about a year since; and this law has operated so satisfactorily, that in the present year (1838), a law has passed prohibiting the sale of ardent spirits in less quantities than fifteen gallons, thus annihilating all the grog-shops in that state at a single blow. A similar measure has been adopted by the state of Tenessee, in the west, at a distance of 1000 miles from Massachusetts, which is in the east, and other states will probably follow their example.

AN ACCOUNT OF SOME NEW INSTRUMENTS FOR TYING POLYPI OF THE UTERUS, NOSE, AND EAR, AND ENLARGED TONSILS; WITH CASES. By William Beaumont, Surgeon to the Islington Dispensary. 4to. 3 Lithographic Plates, 1838.

THE Instruments recommended by Mr. Beaumont are so ingenious, that we wish to introduce them to the notice of our readers. Yet it is impossible to render them quite intelligible without the assistance of the plates accompanying the work. These, from their size, are inadmissible. We shall therefore content ourselves with merely presenting a brief description of the more important instrument, that for tying the polypus uteri, and refer our readers to the pamphlet itself for any further information.

The instrument for tying uterine polypi, consists, among other parts, of two rami parallel to each other, save that one is slightly curved towards its point, so as to correspond in some measure with the posterior parietes of the vagina, and the more readily to allow the body of a polypus to pass between the rami; which parts of the instrument are temporarily joined together at the handle, the distance between them being capable of increase or diminution according to the size of the polypus to be tied. The curved ramus is solely for the purpose of aiding in the placing of the noose around the pedicle of the polypus, and may be removed from the rest of the instrument and from the vagina when that is accomplished. The straight ramus, besides assisting in the application of the ligature, is also, with other parts, attached to it, the means by which the noose is tightened, and rendered unyielding.

This instrument is perhaps somewhat complex, but it should be borne in mind that it is to accomplish a complex purpose. It is first to carry a noose around the pedicle of a tumor in a narrow passage; it is then to constrict the pedicle so far as to strangulate the tumor; and lastly, to jam the running end of the noose in the knot, so as to prevent any elasticity of the pedicle from enlarging the noose.

In describing Figure 2, Mr. Beaumont writes :

"This represents the manner of arranging the ligature, which consists of a common slip-knot noose. That end of the ligature which comes from and forms the knot of the noose is represented by the uninterrupted double line; it is passed through the eye d, and drawn (not very tight) through the hole in the axle k, where it is fastened, by which means the knot of the noose is held at the very point of the straight ramus. The running end of the noose, which is marked by a double dotted line, is passsed through the eye c, through the hole in the axle h, and made fast under the spring i. The noose, about two inches from the knot, or more or less according to the thickness of the pedicle to be encircled, is to be placed in the eye e of the curved ramus, and there confined; the noose is then to be caught about two inches nearer the handle of the instrument at b, between the curved ramus and spring, from whence it is to be carried down to f, and there caught again between the same spring and ramus; it is then to be carried across to the straight ramus, and caught under the spring g. The several parts of the ligature parallel to the rami of the instrument are to be drawn sufficiently tight to lie close, so as not to impede the passage of the polypus between the rami.

To encircle with a ligature, by means of these instruments, the pedicle of a polypus, whether of the uterus, nose, or ear, consists in the mere act of pushing the tumor between the rami of the instrument. The application of the ligature around the neck of the polypus is then accomplished, and little else remains to be done than to tighten the noose so far as to prevent the ingress of blood into the tumor. This, I believe, may always be done at one operation, however large the pedicle; and in cases where its structure is not very firm, I think the constriction might (if it were desirable) be increased to a degree sufficient to sever the pedicle in two, for the instrument has great mechanical power, a small axle and long lever. It certainly would be a mode of excision preferable to that effected by the knife or scissors."

These extracts will give a vague idea of the general character and operation of the instrument. Anything beyond that cannot be obtained without consulting Mr. Beaumont's own account. Mr. B. is evidently an ingenious surgeon.

RECENT WORKS ON SURGERY.

1. A SYSTEM OF PRACTICAL SURGERY, WITH NUMEROUS EXPLANATORY PLATES, THE DRAWINGS AFTER NATURE. By John Lizars, Professor of Surgery to the Royal College of Surgeons, and lately Senior Operating Surgeon to the Royal Infirmary of Edinburgh. 8vo. pp. 220. 18 Plates. II. THE PRINCIPLES OF SURGERY, VOLUME FIRST; CONTAINING THE DocTRINE AND PRACTICE, RELATING TO INFLAMMATION AND ITS CONSEQUENCES, TUMORS, ANEURISMS, WOUNDS, AND THE STATES CONNECTED WITH THEM.- -VOLUME SECOND ; COMPRISING THE SURGICAL ANATOMY OF THE HUMAN BODY, AND ITS APPLICATION TO INJURIES AND OPERATIONS. By John Burns, M.D. F.R.S. Regius Professor of Surgery in the University of Glasgow, &c. &c. 8vo. pp. 554-536.

VARIOUS

Ir is rather singular that, at the same time, two systematic works on surgery should issue from two Northern Universities-those of Edinburgh and Glasgow. The respective authors are both men of acknowledged attainments and abilities, and their opinions on many points of doctrine and of practice would necessarily command attention. It is quite inconsistent with the nature of this Journal to analyse elementary works of this description. We can only introduce them to

our readers, present an idea of their respective contents, and, perhaps, expose the sentiments of their authors on some particular points.

Let us first turn to Mr. Lizars. The present volume is only the First Part of his system. The concluding Part is advertised to appear in December.

The present Part contains-Inflammation.-Arteriotomy.-Phlebotomy.

Suppuration.-Abscess.-Ulcers.-Dissecting-room Wounds.—Mortification.— Diseases of the Arteries, Aneurism.-Of the Veins, Hemorrhage. Of the Bones, Fractures. Of the Joints, Luxations.-Gunshot Wounds.-Amputation.

1. The Edinburgh College of Physicians allow their Fellows to use the Lancet, &c. -After a succinct sketch of the history of surgery, Mr. Lizars sums up thus :— "It is evident, that surgery has only flourished in proportion as it was strictly connected with anatomical investigation, and enriched with medicine or pathological doctrines. At first it was combined with medicine, and in the days of Herophilus, and Erasistratus, Celsus, and Galen, it was also united with medicine and anatomy. After this, when anatomy could only be prosecuted by stealth, surgery continued in a truly deplorable condition, and in the 11th century, was stigmatized by the Council of Tours. In the 12th century the school of Salernum, and also that of Naples, required only one year's study of anatomy for the diploma of surgeon. In the 15th century, we find the great Paré still a barber surgeon, and controlled by the physicians. At Oxford and Edinburgh, the two first universities in Great Britain, anatomical chairs were not established until the last century; and at neither school was dissection prosecuted until this century, and that only at Edinburgh, where the study was not sanctioned by Government till within the last six years. So that it was only at the dawn of medicine, and in the present era, that surgery, blended with physic, became a respectable profession. It is much to be regretted that there exists any separation, since it only tends to depreciate each, as physicians must be consulted in accidents, the province of the surgeon; and the surgeon must be acquainted with the treatment of fever supervening to operation. All, therefore, ought to have the same elementary education, and be qualified for every department. The operating surgeon ought to dissect daily. Lately the College of Physicians of Edinburgh have wisely rescinded a law which prohibited their fellows from using the lancet or the scalpel. Etenim omnes artes,' says Cicero, quæ ad humanitatem pertinent, habent quasi vinculum commune.

The College of Physicians of Edinburgh have displayed common sense and sagacity. It may be questioned whether the one or the other is to be found in the College of Pall Mall East. Recent events have shown the antiquated absurdity of its spirit in the person of its president.

It would be idle in us repeating what we have so often urged, that the education of the surgeon and physician should be similar. Chance, inclination, or convenience may subsequently determine the line of practice, but to that each should carry miscellaneous and common knowledge. If the physicians pursue their former system, it is not difficult to perceive that the surgeons will ultimately strip them of practice. The scholastic learning which sufficed for the descendant of Esculapius, when medicine was system, its doctrines the offspring of dogmatism and authority, and its practice little else than empiricism, is comparatively valueless in the present advanced condition of the science. Its foundations in healthy and morbid anatomy are so deep and so extensive, that whoever is best acquainted with them will be most thoroughly conversant with it. In the long run the class of men who possess the really useful knowledge will obtain its fruits, fortune and fame.

2. Lancet Punctures in Inflammation.

These are, probably, insufficiently estimated and resorted to. Mr. Lizars gives some short but judicious hints in relation to them.

When punctures are made, attention must be paid to the position of the part affected, for unless the return of the blood be in some degree impeded, no blood will flow. Thus when the face is the seat of the inflammation, it should be held forwards and downwards; when the scrotum, it should be immersed in hot water, while the patient stands. The lancet should be held the reverse of that while opening a vein at the bend of the arm, and the point of the instrument plunged that degree of depth corresponding with the structure of the part and the proximity of blood-vessels, and always parallel with the subjacent muscles. It should be entered here and there, or at irregular distances.

3. Chronic Hypertrophy of the Scalp.

We observe the following notice of this affection, which, so far as we know, is not commonly described.

There is, writes Mr. Lizars, a peculiar ulceration with chronic hypertrophy attacking the scalp, which may be considered here. It is more a thickening of the integuments than ulceration, but there are occasionally extensive sinuses, and a profuse secretion of pus, with disease of the periosteum, and even the cranium. It begins by a thickening of the integuments with achores on the surface, both of which make progress, until the skin be puffed up and divided by deep sulci, into compartments of various shapes and sizes; these latter ulcerate and communicate by sinuses, thus undermining and destroying the scalp, and involving the periosteum and even the bone. In some cases, acute pains are felt not only in the head, but all over the body. Some have laboured under rheumatism, others, syphilis. When noticed early enough, the potass destroys this morbid condition of the intcguments, which then heal by means of bread and water poultices. When neglected, the sinuses must be laid open, and only partially if very extensive; the potass must still be applied, and afterwards the poultices. Alteratives, such as the sarsaparilla, or the nitric acid, should be prescribed.

4. Linear Admeasurements for finding and securing the Femoral Artery. We quote the following directions for operating on the femoral artery in the case of popliteal aneurysm, because we think that linear admeasurements are valuable when precise. We know that this is questioned by some surgeons, but nevertheless we are ourselves convinced of its correctness.

"The patient should be placed on a firm table, with his feet at right angles to each other, but the affected separated from the sound limb. The space between the anterior superior spinous process of the os ilium and the spine of the os pubis is to be divided into ten proportional parts, when five and a half measured from the pubes are made the base of an equilateral triangle, which is to be constructed downwards on the thigh, the apex being distad, the base proximad; and the outer or iliac side of this triangle should be extended from the apex twice its length, when the artery will be found to run beneath this line throughout. An incision should then commence at the apex of the triangle, and be continued down the thigh to the termination of the extended line, or proportionally to the depth of skin and cellular tissue, the latter of which is often infiltrated with serum; this incision is to be deepened equal in length to the first, and should pass through the fascia lata, and this cautiously, when the pulsation of the artery will be felt; the artery is then to be denuded to the smallest possible extent of its cellular sheath; the latter of which is to be held up with the dissecting forceps in the left hand, and the scalpel in the right, with its cutting edge parallel to the vessel, and pointing outwards or fibulad."

5. Diseases of the Bursa and Bunion.

"When," writes Mr. L., "the bursa over the olecranon ulnæ is distended with fluid, it may be mistaken for dropsy of the elbow-joint; when the bursa under

the deltoid is diseased, there is often a communication with the shoulder-joint at the bicipital fossa; and a similar connexion as frequently exists between the bursa under the psoas tendon and the hip-joint, which renders disease of these two last bursæ very serious. The bursa superficial to the larynx is sometimes affected, and when it is allowed to rupture, sinuses form; that over the angle of the scapula now and then becomes diseased, and so also that under the tendinous insertion of the sartorius and gracilis muscles.

A species of spurious or adventitious bursæ is apt, in peculiar situations, to be generated or called into action by pressure and friction; for example, in the integuments over the ball of the great toe, over the patellar ligament, and in the club-foot, where it rests upon the ground. That on the tibial or inner side of the great toe seems gradually to multiply, or rather one bursal pouch is formed upon another, constituting what is named a bunion. The lateral ligament of the joint has a compact laminated structure, the laminæ dense towards the bone, and less so towards the skin, as if bursæ had successively formed, or were forming, as fast as the outer one was obliterated. In many instances, the head of the metatarsal bone is changed, the cartilaginous surface being covered with warty granulations. The tumour inflames, becomes exceedingly troublesome, and even causes lameness; it occasionally suppurates, involves the joint of the toe, and leads to amputation. At first, by fomentation and rest, and afterwards, the application of the nitrate of silver in the dry state, and the wearing of a wide shoe, with the sole thicker towards the tibial aspect of the foot, all these evils may be averted."

We may observe, that the affections of several of the bursæ are often mistaken, indeed more often than the contrary. The surgeon should be well aware where bursæ naturally exist, particularly such bursa as are in the neighbourhood of joints. We have more than once seen disease of the sub-deltoidean bursa (not unfrequently a result of rheumatic fever) mistaken for disease of the shoulder. A provincial physician, of some eminence, pronounced a case of rheumatic disease of the sub-psoas bursa, morbus coxarius. We have twice, once during life, and once after death, seen disease of the complicated bursa beneath the obturatur internus, as it winds round the pully of the ischium. During life the case was thought sciatica, or disease of the hip-joint. We repeat, that surgeons are not sufficiently acquainted with the anatomy of the bursæ. The suprà patellar, and some of the other superficial bursæ are familiar to them: but the deeper ones, and especially the articular, are very imperfectly understood.

6. Malformation of the Shoulder and Hip-joints.—We extract some observations, which may be new to some of our readers, on these subjects.

"The shoulder-joint is sometimes so malformed, that the arm and hand are in a state of permanent pronation or supination, and were it not for other malformations, one would suppose the joint had been luxated at birth. I have not been able to get a post-mortem examination of this malformation. The treatment consists in applying pasteboard splints.

The whole arm is occasionally so shrivelled as to resemble the fin of a fish. A superfluity of digits is no uncommon malformation, particularly two thumbs; in this case the outer pollex should be removed by amputation.

The hip-joint is sometimes deficient in its acetabulum, the head of the os femoris resting on the dorsum of the os ilium, nearer its crista than in the normal state. This is an imperfect formation of the os innominatum from some obstacle to the evolution of the bones, and no original luxation of the joint. The children born with this malformation have been in good health, but there is a marked disproportional breadth of the hips, with projection of the trochanters, and obliquity of the thigh-bones. As the child advances and begins to walk, the deformity increases; and still more so, when the pelvis begins to enlarge, and the child undergoes longer and more fatiguing exercise. Then the balancing