« AnteriorContinuar »
the present consideration, which is merely designed to shew, that the general principles of the animal economy, so far as we are acquainted with them, and as they apply to the subject before us, are in favour of curative trials by medicine, rather than adverse to them upon the ground of physiological absurdity. That the crystalline lens, in a state of health, is a living and active substance; and that a change in its organization is perpetually taking place will not be disputed by any physiologist in the present day. Internal agents, apparently of various kinds, which lie far beyond the prying power of the nicest research, have a considerable influence upon this change, and hereby, indeed, not only produce the opacity which we call cataract, but all the peculiar characters by which one species or variety is distinguished from another, and the cataract is rendered black or white, or ferrugineous, or green, or amber in respect to colour; or hard, horny, soft, or even fluid and milky, in respect to consistence. And if internal agents be possessed of these powers, it is possible, whether we be acquainted with them or notr that external agents may also exist, capable of producing effects as considerable. The specific medicines we are acquainted with are not many, and their course of action is entirely concealed from us: yet they are sufficiently numerous, and their influence upon particular organs is sufficiently direct and unequivocal, to induce a belief that other specifics may yet exist, possessing as clear and undeniable a power over other organs of the animal system. Nor can we, even at present, altogether discredit the benefits which are stated by writers of the first character, to have resulted occasionally from a judicious application of some of the remedies in common use.
We are nevertheless ready to admit, and even with a high degree of satisfaction, that the judicious and ingenious improvement given by Sir William Adams to most of the operations for cataract, in whatever way it be intended to remove it, renders all attempts at curing or relieving the disease by medicine of far less consequence than they have been in former times.
The ordinary operations employed for the removal of cataract are the three following:—that of couching, or depression; that of extraction; and that of absorption. Each of these is described at length, as well historically as practically,in the work before us; their respective advantages and disadvantages are very candidly brought together from the best practical writers on the subject: and the dangers and the difficulties, and the various inconveniences accompanying each, being forcibly and alarmingly detailed, not from writings hostile to the particular method investigated, but, for the most part, from the verbal admissions of its chief advocates and patrons, our author proceeds to point out the means by which
the greater part, and not unfrequently the whole of these evils may be avoided by his own method of operating, which he describes with a perspicuity and an ingenuousness that does equal credit to riis head and his heart.
Of the three ordinary modes of attempting to remove the cataract, and which we have just adverted to, that of depression or couching, as it is colloquially called, is abandoned by our author altogether; and for reasons which we confess are sufficiently satisfactory to ourselves, and we have no doubt will prove sufficiently satisfactory to the profession at large. The operation for absorption appears to be Sir William's favourite mode of practice. It is in effect more extensively applicable than any other operation for cataract, and will probably hereafter be allowed, in every instance, to supersede the use of the depressing process, wherever the cataract is capable of division; as the process of extraction, with our author's new mode of placing the lens in the anterior chamber, and then drawing it away through an opening on the outer side, instead of the inferior part of the cornea, will, in like manner, be employed to supersede the same process, wherever the cataract is indivisible from its hardness. We were much pleased with the author's valuable improvement on Cheselden's operation for artificial pupil; it bids fair to be accompanied with very extensive success.
Hitherto most operators, having made their election of a particular mode of practice, have confined themselves to that mode alone, and rejected every other as of inferior value. It is to the credit of Sir William Adams that he employs, without prejudice, such mode as appears best adapted to the peculiarity of the case.
'Those,' says he, ' who practise the older mode of extraction, in general confine themselves exclusively to that operation, whatever may be the age of the patient, the consistence of the cataract, or its complications. From the various species, varieties, and combinations of the disease, described in the first chapter of this book, it must appear evident that no one operation can be equally applicable to all. It is the duty, therefore, of the surgeon to investigate the causes of the difficulties and embarrassments, which give rise to the frequent failures which must necessarily result, when the same operation is indiscriminately employed, and to exert his ingenuity, in order to devise means by which the causes of failure may be avoided. Such has been my endeavour, and I trust that it will not be deemed presumptuous in me, to express the hope, that these objects are in a great measure accomplished, by the adoption of a series of operations, which vary in their nature according to the species of disease to be operated upon.
'The leading principle of my practice is, that the operation effecting the solution and absorption of lenticular cataract, should be performed in all ages, and in every combination, of that species of disease, in preference to all other operations, when it can be done -with safety. This, as already mentioned, is always practicable, when the consistence of the cataract
1,4 admits admits of free division; in which case, I afterwards place a part, or the whole of the fragments in the anterior chamber, where they become absorbed in the space of a few weeks, without producing either pain or inconvenience. But as, unless the cataract admits of having its nucleus divided, it requires a considerable time to effect its absorption, and sometimes also several operations, in order to obviate these inconveniences, I now, in such cases, at once extract it. In performing the operation of extraction, as just described, I have the great advantage of first ascertaining with the needle, whether the cataract admits of division or not, which is not possible where the usual method of extraction is performed; when, however ill adapted the case may be to that operation, or however favourable to the absorbent practice, the patient is, nevertheless, exposed to dangers peculiar to extraction, and from which dangers the absorbent practice is wholly exempt.'—pp. 142—14*.
We cannot but regard this volume as a very valuable accession to the chirurgical library, not of our own country alone, but of Europe. It requires, as we have already observed, to be methodized and condensed; but it is written with an air of candour, with a spirit of research, with a full and comprehensive knowledge of the subject, an ardent love of it, and a successful pursuit of it, which deservedly place its author in the first rank of ophthalmic surgery.
The volume closes with a Supplement, for which we are sorry that there should have been any occasion.—It is in entitled, ' A Letter to the Right Honourable and Honourable the Directors of Greenwich Hospital, containing an Exposure of the Measures resorted to by the Medical Officers of the " London Eye Infirmary," for the purpose of retarding the Adoption and Execution of Plans for the Extermination of the Egyptian Ophthalmia from the Army and from the Kingdom, submitted for the approval of Government.'
Into this we cannot possibly enter, and especially with only one side of the question before us. The case is certainly a very strong one, and drawn up with a manly spirit and deep feeling of injustice. The party, against whom the Letter is directed, will necessarily reply to its charges: but we sincerely lament that, in an honourable profession, and amidst the medical officers of establishments so valuable as those before us, any other contest should exist than the generous one of striving how the public may be best benefited by the means such institutions so extensively possess, and by the talents they are so well calculated to elicit.
Akt. VIII. Naufrage de la Fregate La Meduse,faisant partie de l'Expedition du Senegal, en 18i6. Par J. B. Savigny, Ex-chirurgien de la Marine, et Alexandre Correard, IngenieurGeographe; tous deux Naujrages du Radeau. Paris. 1817. HPHIS well-authenticated little volume presents the details of a •*• scene of horror that can scarcely be conceived to have taken
place among men in a state of civilized society. 'Never,' says a French critic on the subject, 'was there a recital more terrible; it makes one shudder in every page, and tremble at every line. The subterraneous scenes of Ann Radcliffe, and all the imaginary horrors of our melodrames and our tragedies, shrink to nothing before the real horrors of this dreadful catastrophe.'
The French possessions on the west coast of Africa, extending from Cape Blanco to the mouth of the Gambia, having been restored at the general peace, an expedition, consisting of a frigate and three other vessels, was sent, in the month of June 1816, to take possession of them. It was complete in all its parts, as the French expeditions usually are, including men of science, artisans, agriculturists, gardeners, miners, &c. amounting, with the troops, to nearly four hundred persons, exclusive of the crews. The naval part was entrusted to M. de Chaumareys, who had the command of the frigate, La Meduse, of forty-four guns.
Owing to a very relaxed state of discipline, and an ignorance of the common principles of navigation which would have disgraced a private merchant ship, this frigate was suffered to run aground on the bank of Arguin. Attempts were made to get her off, attempts, however, which, according to the narrative before us, were as inefficient and discreditable to the naval officers, as the gross ignorance which had carried the ship into that situation; and it was soon discovered that all hopes of saving her must be abandoned, and that nothing remained but to concert measures for the escape of the passengers and crew. Some biscuit, wine, and fresh water were accordingly got up and prepared for putting into the boats, and upon a raft which had been hastily constructed; but, in the tumult of abandoning the wreck, it happened that the raft, which was destined to carry the greatest number of people, had the least share of the provisions; of wine, indeed, it had more than enough, but not a single barrel of biscuit. No embarkation list had been made out—no disposition of any kind for the distribution of those on board.
There were five boats; in the first were the Governor of Senegal aud his family, in all thirty-five; it might (say our authors) have carned twice as many: the second took forty-two persons; the third twenty-eight; the fourth, the long-boat, eighty-eight; the fifth, twenty-five; and the jolly-boat, fifteen, among whom were M. Picard, his wife, four children, and three young ladies. The military had, in the first instance, been placed upon the raft—the number embarked on this fatal machine was not less than one hundred and fifty; making, with those in the boats, a total of three hundred and ninety-seven. On leaving the wreck, M. Corr6ard, geographical engineer, (one
of the writers of the Narrative,) who had volunteered to accompany his men on the raft, wishing to be assured that proper instruments and charts for navigating it had been put on board, was told by the captain that every thing necessary had been provided, and a naval officer appointed to take charge of it: this naval officer,, however, jumped into one of the boats, and never joined them.
The boats pushed off in a line, towing the raft, and assuring the people on board that they would conduct them safely to land. They had not proceeded, however, above two leagues from the wreck when they, one by one, cast off the tow-lines. It was afterwards pretended that they broke; had this even been true, the boats might at any time have rejoined the raft; instead of which, they all abandoned it to its fate, every one striving to make off with all possible speed.
At this time, the raft had sunk below the surface to the depth of three feet and a half, and the people were so squeezed, one against another, that it was found impossible to move; fore and aft, they were up to the middle in water. In such a deplorable situation, it was with difficulty they could persuade themselves that they had been abandoned; nor would they believe it until the whole of the boats had disappeared from their sight. They now began to consider themselves as deliberately sacrificed, and swore to be revenged of their unfeeling companions, if ever they gained the shore. The consternation soon became extreme. Every, thing that was horrible took possession of their imaginations; all perceived their destruction to be at hand, and announced by their wailings the dismal thoughts by which they were distracted. The officers, with great difficulty, and by putting on a show of confidence, succeeded at length in restoring them to a certain degree of tranquillity, but were themselves overcome with alarm on finding that there was neither chart nor compass, nor anchor on the raft. One of the men belonging to M. Correard had fortunately preserved a small pocket-compass, and this little instrument inspired them with so much confidence, that they conceived their safety to depend on it; but this treasure,above all price, was speedily snatched from them for ever; it fell from the man's hand, and disappeared between the openings of the raft.
None of the party had taken any food before they left the ship, and hunger beginning to oppress them, they mixed the biscuit, of whichHhey had about five-and-twenty pounds on board, with wine, and distributed it, in small portions, to each man. 'Such,' say the narrators, ' was our first repast, and the best which we made during our whole abode upon the raft.' They thought themselves, however, not quite lost; and the hope of speedy vengeance on those who had so basely deserted them tended to revive their courage.