dealing with the cervix is one essential principle of his operation; the other, is the drawing down of the uterus to the level of the fistula. The form of the button is of course adapted to the peculiarities of the individual case. The author does not find any inconvenience from the drawing down of the uterus, either from dragging upon the sutures, or from the displacement. The uterus rises again after the operation. We must refer our readers to the pamphlet itself for the minute details of the operations required in this class of cases. We feel bound to state that the work is a very valuable practical contribution to the surgery of the genito-urinary passages. By ingenuity and perseverance it is now possible, by availing ourselves of the improvements introduced by Dr. Bozeman and others, to cure many cases of a most distressing affliction which a few years ago were regarded as hopeless.

ART. VIII.-Essay on the Pathology of the Blood and its Containing Vessels. By THOMAS WISE, M.D., F.R.S.E., F.R.C.P.E., late Hon. East India Company's Medical Service.-Edinburgh, 1858. pp. 388.

THIS essay consists of two parts. The object of the first part when it was first published in Calcutta, in 1831, appears to have been to describe "the changes in the blood" which occur in "vascular diseases." While the author was still absent in India, the first part of this essay was reprinted in London about ten years ago. To that he has now added a reprint of the second part, on the diseases of vessels, with a few of the drawings in explanation of his views. We think the author has done himself injustice by connecting these two parts together in one volume. When we consider the very valuable additions which have been made to the pathology of the blood by Virchow, Kirkes, Hasse, Paget, Vogel, Becquerel and Rodier, and others, the first part of this book bears evidence of most antiquated pathology. The second part treats of the diseases of the arteries, veins, and capillary vessels, in the space of 104 pages. The whole work bears evidence of much learning, and numerous references are given to valuable facts; but we do not perceive that any new matter is added to science by this publication.

ART. IX.-The Ophthalmoscope, its Mode of Application Explained, and its Value shown in the Exploration of Internal Diseases affecting the Eye. By JABEZ HOGG, Assistant-Surgeon to the Royal Westminster Ophthalmic Hospital, Vice-President of the Medical Society of London, Member of the Council of the Microscopical Society of London, &c.-London, 1858. pp. 107.

THE Ophthalmoscope has become one of the recognised appliances of ophthalmic sur gery, and its value is more apparent as its use is better understood; indeed, it is only by practice that any observer can become familiar with the normal appearances of the interior of the eye, and can recognise the significance of the changes which indicate a departure from its natural state. A magnificent work is now in progress of publication at Vienna, illustrating the morbid conditions of the eye as seen by means of the ophthalmoscope, but the author having the advantage of the "State Press," is enabled to bring out his work at a cost infinitely more moderate than could possibly be done in England, where the expense of good illustrations is fearfully great. Yet without good illustrations, no book professing to exhibit the morbid conditions of the eye can be taken as a safe guide.

In this respect the work before us, excellent in many points, falls short of what might be desired. The first plate (which is printed in colours) is an approximation to the object in view, but several of the woodcuts entirely fail to convey an idea of the truth.

* Beiträge zur Pathologie des Auges, von Dr. Eduard Jaeger. See No. xxxiii. of this Review.

It may be that the copy before us is an exception, but the cuts at pages 89 and 96 are decided failures, partly from the imperfection of the printing.

After a sketch of the history of the ophthalmoscope, Mr. Hogg describes the manner in which it should be used, and adduces various authorities in its favour. The remainder of the work is devoted to the investigation of normal and morbid changes seen by the aid of the instrument. The subject is elucidated by a great variety of facts and cases from several sources. The following throws light on that obscure disorder of vision, nyctalopia-day-blindness.

T. J., aged forty-six, a sailor in the Queen's service, was sent home from Constantinople. In the month of March, while in the Crimea, after having lived entirely on salt provisions, without vegetables, and at the same time exposed to the cold winds and hail during three weeks' work in snow, he was attacked with a bleeding at the nose, which lasted five hours and ceased when he was made warm and comfortable. Four days after this, his eyes were much inflamed, and ran with water. This attack lasted about three weeks, during which time he found he could only see about nightfall. He was unable to find his way about, and was sent to hospital, where he was cupped, blistered, and bled from the arm until he was much weakened, his sight not being in the least improved. He was then sent to the hospital at Constantinople, and a tonic plan of treatment prescribed. After a short lapse of time, he was able to work a little by night, but not at all in the day-time. He tried several kinds of spectacles without benefit. When examined with the ophthalmoscope, the lenses appeared perfectly clear, the retinoid vessels large, numerous, and distinctly seen; over the papilla optica a bluish patch and a general greyish appearance of the optic nerve; the fundus had a curiously mottled appearance, rather dark in colour, like pigmental masses seen through a red gauze; one spot larger and darker was fixed near the inner side of the optic nerve. There were many floating specks of a dark grey colour. The patient was ordered to take mist. ferri co. thrice daily, and continued to do so with advantage until he left England for his home in Hanover. The perusal of this case impresses us with the conviction that the nature of the disorder was thoroughly mistaken in the commencement, and that the depleting system adopted was the worst that could have been devised. The connexion of hemeralopia with scurvy has been satisfactorily established, and though the opposite condition of sight existed here, that in reality was of small importance, whilst there can be no doubt that the poor fellow's blood was impoverished and his system exhausted by the salt diet, the hardships, and the profuse epistaxis. Had he at first been well fed and liberally supplied with bark and lemon juice-a valuable combination-his chances of recovery would have been a hundred-fold greater. The nature of the case seems to have been recognised in the hospital at Constantinople, and also by Mr. Hogg, whose treatment was most judicious.

For other cases we must refer to the little volume itself, which is a useful manual, and may be consulted with advantage by those interested in the study of the eye.

ART. X.-Die Complicirten Luxationen. Von Dr. ALBERT SCHINZINGER, Privatdocent an der Universität Freiberg.-Lahr, 1858. 8vo, pp. 53.

Compound Luxations. By Dr. ALBERT SCHINZINGER.

THE author adduces four cases of compound luxations which he had an opportunity of observing; to wit, one of the radio-ulnar joint, which did well after removing a portion of the ulna; one of the knee forward, from which the patient recovered after secondary amputation; one of the tibia inwards and of the foot outwards, where, after removing a portion of the bone, recovery ensued; one of both tibia and fibula forward and outward, a somewhat rare accident, where the articular end of the fibula was removed and a cure effected. These cases are given in full detail, and the treatment throughout seems to have been judicious. The author next discusses the occurrence and frequency of compound luxations in the different joints, deducing his facts from the writings of

Cooper, Malgaigne, and others. He then enters very fully into the treatment of accidents of this description, under the heads of re-position, resection, and amputation, pointing out the leading indications which ought to guide the practitioner.

ART. XI.-Summary of New Publications.

AMONG the numerous works received during the past quarter, which is always the least productive in the annus medicus, we would first signalize as deserving special attention Mr. Gray's 'Descriptive and Surgical Anatomy,' a work that offers many attractions, and bears evidence of much labour having been bestowed upon it. A physiological monograph On the Thymus in Health and Disease,' by Dr. Friedleben of Frankfort, also gives promise of instruction as the uncut pages yield to the paper-knife. Physiology is further represented by a second number of Dr. Schiff's Physiological Manual.' Hygiene and sanitary science bring us an important and elaborate document by Dr. Greenhow, illustrating the preventive influences that we may exercise over death and disease; Dr. Robertson favours us with a pamphlet on sanitary science, with which may be coupled a brochure by the Rev. H. Leach, On the Dwellings of the Poor.' Dr. Gavin Milroy's paper On the Sickness and Mortality of the French Army during the Campaign in Turkey and the Crimea;' and Mr. Jeffrey's work 'On the Clothing, Housing, and Employment of the British Army in India,' may be mentioned under the same head. Dr. Silvester issues a reprint of a valuable paper 'On the True Physiological Method of Restoring Persons who have been Submerged: and from Oxford we have received Dr. Acland's 'Report on Fever occurring in the Parish of Great Horwood, in Buckinghamshire.'

An important and laborious treatise On the Pathology of the Urine,' by Dr. Thudichum, illustrated in the style of Funcke's well-known Atlas, has come to hand, to which, with most of the works that we can now only dispose of thus summarily, we hope soon to advert more fully. A much enlarged edition of Dr. Radcliffe's well-known work 'On Epilepsy and other Convulsive Affections' has appeared, in which the author enlarges upon, and brings forward fresh arguments in favour of, those views regarding the nature of muscular contraction which are peculiarly his own, and which we analysed when reviewing the first edition. The second part of Dr. West's excellent 'Lectures on the Diseases of Women,' has made its appearance. Dr. Beale continues the periodical publication of his work entitled 'The Use of the Microscope in Clinical Medicine,' of which the third number is before us.

A highly interesting book, equally interesting to the surgeon and to the physician, comes to us from Dr. Friedberg, of Berlin, in which the author treats of muscular palsy and degeneration in a more extended sense than that in which it has hitherto been regarded. Though too late for review in conjunction with Dr. Roberts's work, and though open to various objections, we are able to recommend it already as deserving to be attentively studied. The fifth fasciculus of Mr. Maclise's illustrated work 'On Dislocations and Fractures' has appeared.

Mr. Hood, in a well written pamphlet, records his experience in the treatment of sprained ankles by supporting bandages, applied firmly to the part after subsidence of the first swelling and redness. As a valuable contribution to the history of medicine, we would specially mention Dr. Wilson's elaborate and instructive paper On the Existence of the Castor Fibre in Scotland.' Besides the new Journals spoken of in the Bibliographical Notices, we have to introduce to our readers the first number of the 'New York Dental Journal;' the Irish Roman-Catholic Journal, Atlantis,' contains in its second number some very erudite articles. In conclusion, we would advert in strong terms of commendation to a 'Manual of Photographic Manipulation,' by Mr. Lake Price.

PART THIRD.

Original Communications.

ART. I.

The Bloodletting Question in Olden Times. By THOMAS K. CHAMBERS, M.D., Physician to St. Mary's Hospital.

Now that the question of the propriety of bloodletting in the treatment of disease seems again likely to invite public attention, it may be amusing to our readers, and perhaps not unprofitable, to reflect on the way in which the same subject affected men's minds seventeen centuries ago. It is the duty of an historian to avoid partisanship, and not always wise for him to prophesy; still, it must be remarked that the danger to which we are now drifting seems to be not dissimilar from the prejudices which Galen then found prevalent in Rome. The risk to a patient now is, not as twenty years ago, that he will be bled unnecessarily, but that bleeding will be abstained from when really requisite. Human nature does not alter, though some fallacies leading perhaps to strangely different results enter into our minds through the same portals as they did into our forefathers; and the records of the past, rightly interpreted, cannot but teach wisdom for the future. Let us then fancy ourselves in the metropolis of the world, prosperous and glorious under the rule of the Antonines, in the latter half of the second century, and let us hear Claudius Galen lecture the public in his pleasant chatty style Against certain Erasistrateans' :*

"When I first came to Romet I found some physicians who were so averse to venesection, that sometimes, when a man was scarce able to breathe from congestion, they would not employ this treatment. There was a woman, just under twenty-one, who, after suppression of the catamenia, had a flushed face, with loose cough and dyspnoea, whom they treated by bandaging the limbs and depriving her entirely of food; but they would neither open a vein nor let me do so. And on account of their being acquaintances of the woman's household and senior practitioners, more faith was had in their opinion than in mine. I made no more attempts to persuade them to bleed, but I asked if there was any objection to set up a derivation of blood towards the uterus by means of drugs calculated for that object. And when they consented, I immediately got the widwife usually employed by the patient, and desired her to use them. But she said she had already applied remedies of this sort at the proper time-namely, when the catamenia might normally be expected; and she named the drugsall of tried efficacy-which she had administered to the woman, so that no one could suppose that it was from the inefficiency of these medicines that relief had failed to be given. When I heard this, and moreover that the menses had been already suppressed four months, I had another consultation with the medical men to try and persuade them to bleed. When they refused I wondered why, if they were anxious to evacuate the superfluous blood through the uterus by opening the mouths of the numerous veins there, yet they should think the evacuation injurious when it was made by opening any other vein. They stated that 'superfluous blood could be evacuated by fasting alone,' without having recourse to treatment such as I proposed. So I held my tongue and took my leave, in despair about the woman, on account of the cough and dyspnoea. I expected that she would either spit blood from the chest, or from the lungs by the bursting of a bloodvessel, or would have laryngitis, or pleurisy, or pneumonia; and my hope was, as a choice of evils, that she would have pleurisy, for I was afraid, in case of laryngitis and pneumonia, that the risk would be imminent, and that in case of

* Galeni Opera, Edit. Kühn, vol. xl. p. 187.

+ Viz., in the thirty-fourth year of his age, A.D. 165,

hæmoptysis, that the occurrence of it would be fatal. And such turned out to be the result. For as she was coughing very violently, blood was thrown up. And now some non-professional persons complained of the doctors who opposed the bleeding,; and hopes were expressed that now at least, though not before, they would be shamed into permitting the treatment. When they would not give way, but desired the bandages round the limbs to be tightened, and persisted in the attempt at derivation towards the uterus, and in continuing the starvation, I look my leave, persuaded that I could effect nothing on account of the gentlemen's age and celebrity. And very shortly afterwards the patient was seized with an incurable difficulty of breathing, and died.

"Under the hands of the same physicians who opposed bleeding there also died several patients with laryngitis. And there was another patient, too, who through the whole winter had been living high, and taking no exercise, and in the spring was as red in the eyes and face as a man kept for a long time with his head on the ground and his legs in the air, and he died suffocated after five days' illness.

"Next there was a fourth patient-a woman,-who was ill at the same time that the catamenia were suddenly stopped, whom these enemies to bleeding brought to death's door. They kept her for three days absolutely without food, because she had a continued fever; on the fourth day they gave her the smallest possible quantity of slops; on the fifth they ordered fasting again, and then she got violently delirious, jumped up, and ran screaming about out of doors, and the attendants had great difficulty in restraining her violence. She, however, was saved by nature, through a copious effusion of blood from the nostrils.

"This was a circumstance that should excite our admiration, and at the same time teach us what a powerful influence bloodletting has in such affections, for immediately after the hæmorrhage from the nostrils the woman was freed from all her symptoms.

"Now previously to this I had shunned having any communication with the medical men, guessing what they would say against the use of venesection. But since it was so very clear to all that the woman's life was saved by the evacuation of the blood, I recalled to their memory the fatal cases, expressing an opinion that perhaps those, too, would have been saved if they had been bled. And I gave sundry reasons for it. But these gentlemen involved the matter in a maze of words, twistingthe argument round and round, and up and down, and came to no conclusion. However, they at last ended by taking refuge in Erasistratus, stating that it was 'shown by him in his First Book on Loss of Blood that it was better to apply ligatures to the limbs than to bleed.""

Here is the matter brought to the point. The "blood-funkers” (aipopóВ01)* with an absence of originality truly Roman, had no reason for refusing to bleed beyond the opinion against it of Erasistratus, who had been dead four hundred years. Strongly in accordance with human feelings must his teaching have been to have prevailed so long in opposition to that of Hippocrates and his successors! What could his grounds have been? In the first place, he was an anatomist, and a morbid anatomist; and having observed in the bodies of those who died of febrile affections the arteries congested with black venous blood, whereas in animals or men killed in health they were empty, he thought that the cause of fever was the blood getting from the veins into the arteries. So, argued he, the best way of treating the disease is to keep the blood in the veins; and he tried to effect this object by the expedient of putting ligatures round the limbs. Secondly, he looked to local congestion as the originating cause of all diseases, as well of those commonly called idiopathic as others, and consequently that the treatment of both must be the same. Seeing, then, before his eyes (we may suppose) septic or low fever get well the quicker without bleeding, his theory led him to conclude

This was a nickname bestowed on them by a rich patient of Galen's who was converted to venesection by the rapid cure of his butler's ophthalmia. There is a good deal of humour in our author's account of the man meeting him with open eyes as he got out of his carriage, and of the master's instantaneous invention of the Greek compound for the practitioners who had been trying their hands unsuccessfully on the case for months.-See his Therapeutical Essay on Phlebotomy, chap. xvii.

t See the quotation by Galen's opponents of their master's words in the first chapter of the lecture, “ Καίτοι τὸ πλῆθος τοῦ αἵματος αἰτία τῶν νόσων.” And again, Erasistratus is stated to have ascribed all febrile action to the blood becoming wedged (o¢ŋrwoǹvai) in the arteries. Meth. Med., vol. vii. p. 2.—(Edit. Kühn, vol. x.

p. 461.

Erasistratus was one of the founders of the great anatomical school of Alexandria in the third century before Christ He first traced the origin of the veins to the heart, named the tricuspid valves, and assigned to them their true office, described the lacteals, distinguished the nerves of motion and sensation, and was bold enough to confess he could find no use for the spleen. He was a skilful operator, and invented a sound called for a long time after his

name.