ART. II, Medico-Chirurgical Transactions, published by the Medical and Chirurgical Society of London, Vol. I. 8vo. 310 p. and 10 Plates. 14s. Longman and Co. 1809.

THE purposes for which the Medical and Chirurgical Society was inftituted, are highly honourable to the indivi dual feelings and characters of its members; while their works, if we may judge from the fpecimen at prefent before the public, appear likely to prove of effential benefit to the interefts of humanity. The plan, indeed, upon which the Society was founded, is admirably adapted to promote the objects it has in view; for it is perhaps too much the fault of the prefent ftate of the medical profeffion, that its various branches, (which though in fome refpects they are dif tinct, are collaterally connected), have been rendered too independent of each other. We do not mean to infinuate that this is practically an evil; on the contrary, we confider that the general good will be beft fecured by their being kept as diftinct as poflible in practice. But each branch Springs from the fame root, is nourished by the fame principles, and it is to these fundamental principles we must have recourse when we wish to extend and improve our know. ledge, in any one part of the profeffion, Every effort there fore fhould be exerted to keep up an intimate communica. tion between all the divifions of the healing fcience. It must prove of mutual advantage, and will tend to expand our views, while we deem it expedient to confine our practice.

"The union of gentlemen in both branches of the profeffion" (medicine and furgery) " affords a greater facility of obtaining accurate information on many points of practice than could have been derived from a fociety compofed of either phyficians or fur geons alone." Preface, p. v.

Among those who have adopted this liberal sentiment, are many perfons whofe fituations as officers to hofpitals, and other extenfive charities, must afford them innumerable op portunities for becoming acquainted with facts, relative to difeafe in all its variety of modification. Thefe circum ftances can in no way be more properly brought before the public, than through the medium of a Society formed for the exprefs purpose of " an interchange of practical knowledge," and bringing forward communications likely to contribute to improvement in the science. We may add, that practical obfervations will appear in a more attracting form,

when

when published as the tranfactions of fuch a fociety, than when prefented to us in feparate tracts, or diffufed through a more voluminous and laborious work. We wish it there." fore, upon every account, to be underflood, that the nature, and objects of the inftitution, have our most unqualified approbation.

Having thus far declared our fentiments, we fhall now proceed to examine into the merits of the feveral tracts, or papers, of which this volume is compofed; but as they are the productions of a great variety of authors, much inequality in their refpective value muft of course prevail. It will indeed be impoffible, without exceeding the limits within which we are neceffarily confined, to give a feparate view of all the different papers; we fhall therefore content ourselves with particularly noticing thofe which we deem of ellential importance, and more generally paffing over the remainder.

It is always pleafing, upon opening a book, to find it excite intereft in the first pages. The cafe of Aneurism of the Carotid Artery, and the furgical effort exerted towards the cure, detailed by Mr. Aftley Cooper, introduces the work to our notice in the most impreffive manner. We do not hesitate to pronounce this, and the Seventh Paper, written upon the fame fubject and by the fame gentleman, as together forming the moft inftructive and interesting part of the publication. They furnith us with a fpecimen of that fimplicity of ftyle, perfpicuity of compofition, and accuracy of detail, fo peculiarly valuable in medical writings and offer an example, which we thall be moft happy to fec followed by future profeffional authors. The two cafes together form a complete hiftory of the operation of tying the artery in inftances of carotid aneurifm; an operation never hitherto attempted, and which from the nature of the difeafe, and the importance of the part in which it is fituated, muft be confidered of much difficulty and delicacy. Mr. Cooper, in a very fhort compafs, has not only prefented us with an accurate and mafterly account of the operation itself, but likewife with a hiftory of the progrefs made, from the period of its being performed, till the obliteration of the artery, and the difappearance of the aneurifmal tumour, were completed. To perfect the hiftory, he has given us a detail of the appearances upon diffection, in one of the cafes which, though it proved fatal in the event, afforded fuffieient encouragement to this excellent operator to profecute the attempt in future, under certain reftri&tions. A comparifon of the particulars of the two cafes is highly gratify

ing; and, taken together, it will be found, that they efla blith the following important facts, in a manner the most fatisfactory.

ift. "It appears that no objection can be made to this opera tion, on account of any unufual danger of bleeding, at the time the ligatures feparate." P. 10.

2d. That there is "no apprehenfion of the functions of the brain fuftaining any permanent injury from a ligatúre on the carotid artery." P. 225.

And 3d. That the operation of tying this artery may be performed with every profpect of fuccefs "before the difeafe has advanced fo far as to interrupt; in a confiderable degree any other func tion than that of the paffage of blood through the carotid ar tery." P. 223.

Speaking of the cafe, the refult of which "afforded a degree of pleafure which compenfated for the difappointment felt in the iffue of the former," Mr. Cooper concludes with a remark, which, as it may influence future cafes of a fimilar nature, we fhall give in his own words.

"This ancurifm, from the depth of its fituation, was, I be. lieve, feated in the internal carotid artery, and this led me to hope that the regurgitation of the blood, although at firft fufficient to produce a flight pulfation in the tumour, would not continue to fupport its growth, because as the internal carotid paffes through a foramen in the skull, a little above the fwelling, it could not dilate at that part to bring down any additional quantity of blood into the fac; fo that its first effect was likely to be as great as any it could produce. But if the aneurism had been of the external carotid artery, owing to the number of communicating veffels, I fhould not have been equally fanguine in my expectation that the pulfation would have ceafed, as I have known two inftances, one of a wounded radial artery, and the other of aneurifm of the anterior tibial, in which the tumour continued to grow by anaftomofis, after the arteries had been tied above the fwellings." P. 233.

It appears to us, however, that the depth of the fituation. of the aneurism would point out its having been feated in the external, and not the internal carotid artery; for these arteries do not take their names from their relative fituation in the neck, but from the parts which they afterwards fupply with blood. The fact is, the internal carotid artery is the moft externally fituated, at the place where the two trunks divide, and afterwards twifts across the external carotid, as it proceeds to fupply the internal parts of the head, while

the

the external branch extends itself over the face, and the outfide of the head.

The next paper which we fhall felect, principally on ac. count of our having commenced with the furgical parts of the work, is a cafe of lithotomy, written by Mr. Thomson Forfter, fenior furgeon to Guy's Hofpital. Previously, however, to our remarking upon it, we cannot withhold our approbation of the feeling which he has expreffed as principally influencing him in its publication. Much important and ufeful information is undoubtedly to be derived from an acquaintance with fuch methods of cure, and fuch cafes as men of great experience have found to be ineffectual and unfuccessful." The cafe before us is, upon the whole, well detailed, and the reafons of its failure clearly pointed out. The recapitulation of fome of the leading cir cumftances is drawn up at the clofe of it in a concife and intelligent manner. It is obferved that,

"The unufual fufceptibility to inflammatory action, that fhowed itself fo often over the whole belly, is a symptom not very frequent; and when it does occur, is rarely overcome. Moreover it appears from this cafe, that each fucceeding inflam matory attack made fuch havoc in the conftitution, as to bring on worfe fymptoms, and increafed debility." P. 106.

Hence Mr. Forster advises, that, after due time be allowed to allay immediate fymptoms, recourfe fhould be had to the operation, notwithstanding fuch fufceptibility, without waiting till the bladder, by repeated attacks, had loft its power of mufcular action; for in that cafe " great doubts may arife as to the propriety of venturing on the operation at all:" the parts being in an unfit ftate to fupport the new action, which it is neceffary fhould take place to complete the healing process.

The only remaining papers that can be ftrictly confidered furgical, are cafes of artificial dilatations of the female urethra, and of the rectum, by Mr. H. L. Thomas; and a paper, inviting the attention of furgeons to the confequences of gouty concretions, or chalk ftones, by Mr. James Moore. We have to regret that the limits which the author of the latter has prescribed to himself, prevent him pursuing a hitherto " unaccountably neglected fubject," fo far as to be of much practical advantage. We truft, however, that at fome future period Mr. Moore will complete a work which he has with fo much judgment commenced; and will himfelf fupply the deficiency he has pointed out, as having been improperly

improperly fuffered to exift, in that branch of the profeffion to which the ultimate confequences of gouty concretions may be moft correctly referred.

There are feveral excellent tracts upon anatomical fubjects, together with an account of two fingular phenomena, which have of late come to our knowledge, refpecting the natural history of the human frame. Thefe latter, however, are facts fo clearly afcertained, and fo little important in a practical point of view, that we fhall content ourselves with barely naming them. The one is an inftance of the formation of a fpecies of monftrofity, having "unequivocally the fhape and characters of a human foetus," in the abdomen of a boy; and the other is a deviation from the usual course of nature, which, though rare, has been noticed as having occurred, from the earliest periods of the natural history of man; namely, the premature arrival at the flate of puberty. The inftance now prefented to us certainly appears to be the most perfect cafe of the kind we have upon record.

Among the many very useful accounts of morbid structure, which this volume contains, we have been particularly attracted by the defcription of fome circumflances relative to the diseased action of the heart, and arteries, into which an investigation appears to have been purfued with much anatomical accuracy. The papers to which we allude are thofe of Mr. Abernethy, Mr. Dundas, and Mr. Chevalier; though the circumftances noticed by the latter gentleman cannot strictly be referred to any morbid alteration of ftructure. Although Mr. Abernethy has, in his description of a morbid appearance not uncommon, launched into the mazes of fpeculative enquiry, and has plunged fomewhat beyond his depth, in his efforts to dive into the causes of the pecu-> liarities he defcribes, yet he has nevertheless prefented an accurate, and therefore useful statement of the morbid appearances, found upon diffection, in the cafes from which he has drawn his arguments. He has likewife difplayed a confiderable degree of judgment in forming his opinion of the precise nature of the disease, previously to death.

"Notwithstanding the refpiration was laborious and frequent, it ftill appeared too free to admit of the fuppofition, that the left savities of the heart received the blood in fuch small portions, in confequence of an impediment to its tranfmiffion through the lungs. I therefore conjectured, that a mechanical impediment prevented the left ventricle from receiving its due quantity from the auricle. P. 29.

The