cutaneously the edges of the hernial opening-be it inguinal, femoral, or umbilical-and getting up a degree of inflammation which leads to consolidation and closure of the aperture through which the bowel protrudes. Of course, the steps of the operation vary in each particular case with the anatomy of the parts, but the principle is the same in all. For the details we must refer the reader to Mr. Wood's descriptions, and to the excellent drawings by which they are illustrated. By the help of these, anyone who is tolerably familiar with anatomy can soon make himself master of the operation, though the skill, which is so necessary to distinguish the different tissues which are felt when the finger is introduced along the track of the rupture, is a thing which can only be acquired by practice. In pointing out the leading principle of Mr. Wood's operations we have said enough to show how they differ from all others which have been proposed for the same object, particularly from Wutzer's, which is the only one that has obtained any favour of late years.

"It will be seen that in the various methods originated and practised by the author for the cure of hernia, this novel principle of compression and closure of the tendinous sides of the hernial canal in its entire length prevails throughout. In this important particular they differ entirely, both from the older and more modern operations; all of which either deal with the sac almost solely, or rely upon the principle of dilatation or plugging of the canal." (p. 90.)

Mechanical appliances have now been carried to such perfection, and so much has been done to make ruptures tolerable by improved trusses, that we are not justified in recommending any operation attended with much danger, and hence it happens that various heroic proceedings which have from time to time been proposed have fallen into disuse, and are now only remembered as interesting facts in the history of hernia. An account of some of these will be found in the volume before us.

Mr. Wood's operation is a good example of the triumphs which we may fairly expect will result from the attention which is being paid now-a-days to the details of every branch of medical and surgical science. It is not a remedy which has been thrown in our way by chance a haphazard cure, like some of the older methods-but it is a deduction based upon a thorough knowledge of anatomy and pathology. Every now and then we may be fortunate enough to hit upon a specific remedy like quinine or iodide of potassium; but the only progress which we have a right to look for and to expect is that which results from our own minute observation. Careful study and research cannot fail to lead to important conclusions; indeed, by these means many triumphs have been already achieved, and among the most recent we may place the operation under consideration.

The results which Mr. Wood has obtained are, on the whole, very favourable. He wisely abstains from making himself answerable for the operation in the hands of others, and the conclusions which he draws are founded entirely on the cases which have been treated by himself. Out of the 60 cases on which he has operated, and of which

the appendix contains a full account, there has been only 1 death, and that from pyæmia, three weeks after the operation. In 11 cases the rupture has returned after a longer or shorter time; in 6 more the result is doubtful, while in the remaining 42 it has been successful. We have therefore a proportion of 65 or 70 per cent. of cures; and in estimating these results, we must remember that the cases have not been selected, they have been taken almost indiscriminately. Wherever a case presented itself in which an operation was not clearly forbidden, Mr. Wood has been willing to put his method to the test. And further, we must bear in mind that the operation has gone through several modifications, and perhaps it has hardly yet reached its full development. Here, as it so often happens in surgery, the credit of the operation will greatly depend upon a judicious selection of cases; but when this is made, and the operation is properly executed in its most approved form, we may expect a still larger proportion of successful results.

Is this balance of success such as to induce those who are affected with rupture to incur the risk of the operation, and to justify us in recommending it? Among the upper classes-those whose occupations are very light, and who can afford the best of trusses—the opportunities of performing the operation will probably not be so numerous as among the middle and lower classes. But wherever we meet with a rupture that is not easily controlled by a truss, and that is apt to descend when any unusual exertion is made, giving rise to painful and dangerous symptoms, there we may fairly set before our patient the operation for a radical cure, and we have no doubt that many would be glad to purchase future comfort and safety at the cost of a slight present risk. Among children the operation is so very successful, and, as far as one can judge, so free from danger, that we may well join Mr. Wood in hoping that some day it will be as commonly performed upon infants of all classes as the operations for hare-lip or club-foot now are.

The treatise before us contains some useful sections on trusses. Mr. Wood points out the disadvantages of those now in use, and the true principles upon which pressure ought to be applied; and he gives drawings of the "ring" and "horse-shoe" pads which he has introduced, and which he has found very efficient in practice. The convex pad of the ordinary truss tends to dilate rather than to contract the hernial opening, and when applied after operation the pressure promotes the absorption of the adhesions upon which the cure depends. This led Mr. Wood to devise the " ring" and "horse-shoe" pads for direct and oblique hernia respectively, and by these means pressure is exerted upon the sides of the aperture, and not immediately over it. This improves our chance of curing ruptures by truss-pressure alone, and after operation it avoids the danger of absorbing the recent adhesions.

The appendix is, as we have said, one of the most important parts of the volume before us. It contains a detailed account of 60 cases operated on by the author, and a review of these furnishes us with several interesting observations.

may

It be asked, how far the cures effected by Mr. Wood deserve to be called "radical" and "permanent"? Have they stood the test of time and the wear and tear of life? The best answer that we can give to this question is supplied by the first case in the appendix. The patient, a printer, aged twenty-five, was operated on in April, 1858, for a direct inguinal hernia:

His

"After seven months the use of the truss was entirely discarded. occupation has necessitated the frequent lifting and removal of heavy 'forms' of type, which often weigh as much as a hundred-weight. On the last occasion," when he was seen," (a few months ago), the groin operated on could not have been distinguished from the other, except by the presence of the small scars. No impulse whatever, or any bulging, was observable." (p. 264.)

Again, as we have before mentioned, among the 60 cases there has only been one death, and that from pyæmia, three weeks after operation, and when the patient was convalescent. This seems to show that the proceeding is not attended with any special or peculiar dangers.

Again, we hear little or nothing of peritonitis, which one might have expected to have been a fruitful source of anxiety. On two or three occasions some slight symptoms arose, but they were easily met and speedily disappeared. This confirms the opinion which is now gaining ground, that we may deal with the healthy peritoneum with more impunity than was formerly thought possible.

Again, it is remarkable how little, on the whole, the patients seem to suffer; indeed, several of the children, on whom the operation was performed with "rectangular pins" could hardly be said to suffer at all.

In a few places the diction of Mr. Wood's book might be improved; but we are not disposed to find fault with it, for as a whole it belongs to the highest class of surgical literature. The author, moreover, commends himself to our minds by the candour with which he lays before us the history of his operation. Nothing seems to be kept back; everything is told, and we are put in possession of all the data for forming an opinion. We expect to see Mr. Wood's operation take its place among the recognised means of dealing with rupture, and we shall be glad to note its further progress, and to observe what results it yields upon a more extensive trial, and in the hands of other surgeons.

REVIEW III.

Physiological Memoirs. By WILLIAM HAMMOND, M.D., SurgeonGeneral United States Army, late Professor of Anatomy and Physiology in the University of Maryland, &c.—Philadelphia, 1863. pp. 348.

THE memoirs which form this volume, we learn from the author in his modest preface, are a reprint, and that they were for most part first published in the American Journal of Medical Sciences.' As a

whole, they impress us favourably with the candour, accuracy, and ability of the writer. He enters on his inquiries in the true spirit of the experimental physiologist, and duly impressed with their importance. He justly remarks: "It is only by actual experiment we can ever hope to lay the foundations of true physiological science;" that "the day of extravagant theories, unsupported by observation, has gone by, and that he who has nothing better to offer than the unsustained creation of a dreamy mind meets with but little attention, and merits still less than he receives."

Would that those philanthropists, and more especially philanthropists of the medical profession who take an active part in the great temperance agitation now going on, were of his way of thinking; then we should have better hopes of a successful issue of their exertions, and we should be at least spared the reading of much idle declamation and erroneous doctrine-the latter little creditable to the zealots who, like bigots in religion, fancy themselves almost infallible, and write and speak oracularly.

The subjects of Dr. Hammond's researches are various, and many of them are highly interesting and important. The zeal he has displayed in conducting them is most meritorious,-not made in corpore vilo, many of them, such as his trials on certain articles of diet, having been made on himself, at the risk of health, and persevered in, in one or two instances, even after the production of disease. He justly observes:

"There are many obvious advantages to the physiologist, and also to the science which he represents, in basing his conclusions, whenever practicable, on investigations instituted upon himself. He is assured of their correctness, and knows fully the conditions under which they are performed. On the contrary, when others (such at least as are most likely to come under his observation) are the subjects of his researches, he can never be certain that his directions have been complied with, or that he has not been otherwise deceived."

In expressing the high sense we entertain of the work, we must not omit to point out the goodness of its style, so clear and simple, and so appropriate to the matter, nor, though briefly given, the information he affords of what has been accomplished by others in the same field of research.

We shall, so far as our limits permit, notice the several memoirs seriatim, oftener than we could wish giving merely the principal results or conclusions.

In the first memoir he has endeavoured to determine whether the theory of Liebig, in regard to the formation of urea from uric acid, could or could not be sustained by further investigation. The conclusion he arrives at from his experiments is rather affirmative, but is not absolutely conclusive. According to that theory, the more the blood is oxygenated the more should urea predominate in the urine, and the less the uric acid. In trials on himself he found that when using active exercise there was a diminution of uric acid and an increase of urea in the urine; and, as agreeing with this, he

refers to the well-known fact that the urine of certain animals remarkable for activity-lions, tigers, and dogs-abounds in urea; whilst of certain others of sluggish habits-serpents, for instance-feeding also on animal food, it consists almost entirely of uric acid or urate of ammonia. In an experiment on a snake, he found, in accordance also with the theory, that whilst its activity was augmented by giving it oxygen to respire, urea, not before present, then appeared in its urine. The result is a curious one, and were it confirmed on repetition of the experiment-the experiment was a single one-it would be a significant fact. Opposed to the theory, as he admits, there are other facts—for example, the urine of birds, creatures of high temperature and extreme activity, yet consisting chiefly of the acid in question. We will add another instance, one he does not mention-the urine of the batrachians, which, not excepting even that of the indolent toad, bears a nearer resemblance to the urine of the lion and the other felidæ, than to that of the snake, its principal ingredient being urea. Whether, as he thinks, future investigations will do much towards the establishment of Liebig's theory, seems to us, we must confess, very doubtful.

In his next memoir, the second, entitled "Urological Contributions," he considers the effects of coffee and tea upon the urine, and incidentally upon the system generally. From well-conducted experiments on himself, the conclusions he comes to, and we think in a very satisfactory manner, are:

"1. That both tea and coffee are excitants of the brain and nervous system, and at the same time considerably retard the metamorphosis of the tissues.

"2. That tea possesses a more powerful influence in restraining the destruction of the tissues than coffee; whilst this latter substance is a greater stimulant of the cerebral faculties and of the nervous system."

His third memoir, "On the Excretion of Phosphoric Acid by the Kidneys," we pass over, his experiments, though deserving of the attention of the physiologist, being, as he admits, not sufficient in number to allow of definite conclusions from their results.

His fourth memoir is on the important subject of "The Physiological effects of Alcohol and Tobacco on the Human System." Admitting with other inquirers that alcohol contributes nothing to the production of tissue, he concludes from his experiments "that it increases the weight of the body by retarding metamorphosis of the old tissues, promoting the formation of new, and limiting the consumption of fat." The effects he observed on his own person during five days, whilst he was using four drachms of alcohol diluted with an equal quantity of water at each meal, were the following:

"1. The carbonic acid and aqueous vapour given off in respiration were lessened in quantity.

2. The amount of fæces was diminished.

"3. The quantity of urine was reduced.

"4. The urea, chlorine, and phosphoric and sulphuric acids were diminished in amount."

He adds and his words are especially deserving of attention, as