A Defcription of all the Burfæ Mucofe of the Human Body, illuftrated with Tables. By Alex. Monro, M. D. Folio. 125. in Boards. WE Elliot. E are much indebted to Dr. Monro, for a defcription of those cavities, which have either escaped the notice of former anatomifts, or whofe ftructure and fituation have been mifrepresented, or misunderstood. Yet, for the reafons which we once gave*, these anatomical investigations, though they are almost exclusively the discoveries of Dr. Monro, will not be wholly new to our readers; they have been for fifteen years described, in part, in his lectures, mentioned by his pupils, and demonstrated by other lecturers. They were first pointed out diftinctly by Albinus, who mentions but a few: at present, however, 140 are well known, and accurately defcribed. They occur entirely in the extremities, and are defigned to prevent the friction of tendons, to give an eafe and a facility of motion, by containing a fluid capable of expanfion and compreffion. They are placed fometimes behind, fometimes before, the tendons; between contiguous tendons; between tendons and ligaments; where the proceffes of bones play on ligaments; or where one bone plays on another. Sometimes a few burfæ of contiguous tendons communicate with each other, and fometimes their cavities communicate with those of the neighbouring joint, without impairing its motion. Burfæ are even discovered between the most moveable bones of the carpus. A particular defcription of the cavities follow: it is illuf trated by tables, of which we can only fay, that they are not uniformly black; though, after a little inspection, they really appear to bear a distant resemblance to what they were defigned to represent. We cannot always fay fo much for the illuftrations of Dr. Monro's works. The burfa is compofed of a very thin, and a very denfe membrane; even with this affiftance, it is not expofed to the friction of a bone, without the interpofition of a layer of cartilage, or fomething which resembles it. In the cavity a mass of fat, with reddish borders or fringes, is fufpended; and the internal furface is lubricated by a flippery fluid, probably, in the living body, in a ftate of vapour, and refembling the finovia of the joints. Indeed, in the most effential respects, the cavity of a bursa, and of a joint, resemble each other. Fat, in general, Dr. Monro thinks, is contained in vafcular follicles, from the internal furface of which it is fecreted, and through which it is again ftrained, without any perceptible organic duct; it is nearly * See our Review of Monro's Nervous System, vol. LVIth, p. 259. Vol. LXV. June, 1788. Ff the the fame in the joint; and the oil of the fatty bag is, in our author's opinion, united with the watery or mucilaginous fluid, excreted by the fides of the cavity of the joint or burfa. : The fimilarity between the burfæ and the joints is proved alfo by disease the cavities communicate with each other, we have faid, without injury; they are both fubject to drepfies, to fcrophulous fwellings, and to little cartilaginous tu mours, which generally grow from, and are nourished by means of a peduncle. Membranes of each when found, have little fenfibility, and very great when wounded. The accefs of air is highly injurious to both. Dr. Monro thinks that there is alfo fome fimilarity between the membranes of the burfæ, the pleura, the pericardium, and the peritoneum. In the cavities of the latter there are no fatty fimbriæ, and confequently their fluids must be different. But we are told that, in a hydrocele of the vaginal coat of the tefticle, there were found four finall cartilaginous bodies: one of these adhered flightly to the epididymis. As the cavities of the burfæ are fo eafily affected by the admiffion of external air, Dr. Monro is naturally led to confider the cause of the dangerous inflammation, which gene. rally follows the wound of a shut fac. This caufe is pretty certainly the accefs of the external air; and the means of preventing the effect is undoubtedly to leffen, as much as poffible, the contact of this injurious fluid; fometimes by wounding the skin, after it is drawn up, fo that the orifice of the inte guments may not coincide with that of the cavity; when the cavity is perforated with a trocar, by paffing it obliquely; in a tympany or a parcentefis of the thorax, for difcharging effufed air by fucking out the remaining air by a fyringe or an elaftic bottle; by ftitching the wound with more accuracy than asual; by addrefs and quickness in the operation. Much of the danger, in the high operation of the ftone, arofe, in our author's opinion, from this caufe; and fo much of the danger in the operation of the hernia is owing to it, that he advifes us to divide the tendon only, and not to open the fac, unless there be an adhefion or a certain mortification. Even a flight tendency to mortification is, he feems to think, lefs dangerous than the accefs of air to the cavity of the peritoneum, or to the furface of the intestines. As this is, however, a subject of importance, let us felect our author's own directions. Several dangerous cafes are adduced to confirm their propriety by fuccefs. If the furgeon is not called till the bowels are evidently in a state of mortification, the method recommended by authors is to be followed. But if he is called in proper time, after trying in vain the ordinary ordinary method of reducing the bowels, he ought to operate more early than is commonly done, or before the inflammation can have produced adhesion; in which cafe the operation, after dividing the fkin, fhould confift merely in the taking off the ftricture by cutting the tendon. In this cafe, after the fkin, oppofite to the ring is cut, the stricture is to be taken off by dividing the tendon; after which the bowels may, by gentle preffure, be returned into the abdomen, without any danger of their fuffering by being twifted; the inflammation which follows the divifion of the tendon, especially if the fides of the incifion in the fkin be joined by ftitches, will scarcely be greater than where the skin alone is divided. By the by, I would here obferve, that the divifion of the tendon in the crural hernia is not attended with that degree of danger which fome of the latest and most eminent writers have fuppofed, providing the edge of the knife be turned toward the umbilicus; in which direction both the epigastric artery and spermatic chord are at the greatest distance from it; and that the knife be used like a faw, dividing cautiously with it one tendinous fafciculus after another. If after dividing the tendon, the bowels cannot be easily returned into the abdomen, there may be room for fufpecting that they are confined by a ftri&ture of the neck of the fac, efpecially in the hernia congenita; which must therefore be in the next place removed. If the herniary fac under the ftraitened place of its neck be thin and tranfparent, and that there is little or no reason to fufpect an adhesion of the bowels with the fac, the best method will be to make a small hole in the fac below the ftricture, and then to introduce a fmall furrowed probe, and to cut cautioufly upon it but if the fac be thick and dark coloured, and that there is likewife a fufpicion that the bowels may adhere to it, the easiest and fafeft manner will be to make the hole in the peritoneum above the ftricture; then to introduce a common probe, bent near its point into a femicircle; and to introduce this with its point directed downwards, through the ftricture into the fac; and, upon the point of it, to make with great caution. another fmall hole after which we may either cut upon the probe, or introduce a furrowed probe, and divide the neck of the fac. After this the bowels are to be returned by a preffure upon the fac, without opening it further; and the wound in the kin is to be stitched fo accurately, by paffing the ftitches about the breadth of the finger from each other, as to prevent the access of the air. The wound in the fkin ought likewise to be dreffed with large pieces of lint fpread with iimple cerate, and these fhould be covered with a comprefs. In the hernia congenita, when the bowels are in the fame fac with the testicle, it is ftill more neceffary than in the most common kind of hernia to avoid opening the herniary fac, as Ff 2 the the inflammation of the testicle would add confiderably to the danger.' Dr. Monro thinks Mr. Pótt to have been inaccurate in saying that a hernia, from early infancy, is probably a hernia congenita; and that there is neither any external mark by which it is poffible to distinguish it from a common hernia, or any utility in the diftinction. In the firit, he says that the bowels push down between the fac and the forepart and fides of the testicle, fo as often to conceal it in a great measure: in the latter, every part of the testicle can be felt diftinctly. The utility arifes from the greater danger of permitting the air to have access to the testicle, and from the neceffity which there is, in operating on the hernia congenita, to exclude it carefully. The remaining plates represent the fimbriæ and the fatty fubftance of the joints and burfæ, of their natural fize, and magnified; the globules of fat magnified; different views of a great variety of cartilaginous bodies, and holes in the coats of the intestine, either eroded by the acrid matter of a dysentery, or formed by pins which had been fwallowed. We cannot conclude without thanking our author for this ufeful anatomical work: ofthe chirurgical part, we have given no opinion, because we wish to speak of it after some cautious trials. Of the practical part, relating to dropfies of the joint, and of the burfæ, we can fpeak from experience, with commendation, though the author does not give quite fo much credit to purgatives as we think they deserve. hope Dr. Monro will next turn his attention to other parts of the fresh joints; as this branch of anatomy requires yet many explanations. We Remarks on Jofephus's Account of Herod's Rebuilding of the Temple at Jerufalem. By T. Burgess, A. M. Fellow of C.C.C. Oxford, and Prebendary of Salisbury. 80. 2s. 6d. Elmfly. THIS is a very valuable and learned criticism on Jofephus's account of Herod's rebuilding the temple at Jerufalem, intended as an answer to a pamphlet which we reviewed in our LXIIId volume, p. 263. This work was defigned to show that, in reality, Herod enlarged and adorned the temple, inftead of rebuilding it. Haggai's very pointed prophecy of the glory of this fecond temple is not very confiftent with the ftate in which it then was, unless it be confidered as relative to our Saviour; and it could not relate to him, if the temple were not the fame. The opinion of the author of the Evidence, we were well aware, was conjectural only; but the conjecture feemed a happy one, and an hypothefis in philosophy no no longer is called fo, if it explains the phænomena. It is true, indeed, that it must be fupported at the expence of Jofephus's accuracy; and Mr. Burgefs is unwilling to allow any imputation of that kind, on an hiftorian whofe hiftorical evidence relating to our Saviour is confidered of much importance. A difputed paffage, of no great value, need not awake any very confiderable apprehenfions. If Jofephus be fuppofed correct in his facts, and in his language, the chain of evidence in the former pamphlet falls to the ground. But the words of Haggai, foretelling the glory of that temple, which filled the eyes of the Jews with tears on account of its infignificancy, in comparison with Solomon's (Hag. ii. 3.) muft furely relate to a future ftate of ornament, or some event which would give a luftre fuperior to any ornament. If Herod rebuilt the temple, there is no proof of any glory of either kind. If he added to its height and fplendor only, the accounts are fufficiently compatible. The whole of Mr. Burgess's argument is not before us. He begins with attempting to prove, that Zerubbabel's temple was in reality of equal dimenfions with Solomon's, and that each was 60 cubits in length. Yet, on this fubject, there is no little difficulty: the accounts are different in authors who fpeak of the whole extent, or of the extent of the internal parts within the walls. But if, after examining the whole tenor of the defcriptions, it appears that there was no difference in the length, or in the breadth of the two temples, fo much of the former author's hypothefis must be abandoned; and fo far our author has proceeded with fuccefs. His philological criticifms and his interpretation of Jofephus are, in general, accurate. The paffage in Haggai, which we have quoted above, in Mr Burgefs's opinion, relates to the desolate ftate of the temple; but he certainly could not compare a building not in existence to its ftate while it exifted. There could be no objects of comparifon; and it is more probable that the meaner condition of the new temple was the foundation of the question. This opinion is fupported by the other paffage, coming foon afterwards in the fame prophecy, where an existing temple is pointed out, by the words this latter house. Mr. Burgess does not explain the caufe of the Levites' weeping when they faw the foundations laid (Ezra iii. 12.) very fatis. factorily. Their reinstatement, and the probability that, after various delays, they might fee the temple restored, would undoubtedly affect their minds very ftrongly, and tears are always the fign of a very powerful agitation.-After what we have faid of the hypothefis of the author of the Evidence, the fol Ff3 lowing |