pervening on scrophulous enlargement and scirrhus of that viscus.

SCROPHULOUS SPLEEN. Scrophulous tubercles, according to Mr. L. form in this organ in the same manner as in the lungs, but they generally acquire a larger size, sometimes, however, they are numerous, very small, and diffused through the whole gland. Dr. Baillie believes they are much more rarely formed in the spleen, than in the Inngs, but they are precisely of the same nature in both.

GASTRIC AND INTESTINAL SCROPHULA. We shall pass from what Mr. Lloyd has written on this branch of the subject and copy Dr. Monro's description of scrophulą as it appears in the alimentary canal.

"Scrophula of the alimentary canal is a disease which, though frequent, has not been described with sufficient accuracy. When the stomach and intestines become the seat of scrophula, all the coats of the part affected attain an unnatural thickness. I have seen the coats of the stomach half an inch thick, and instead of being heavier and harder, and indurated, as from scirrhus, they become softer, and more of a spongy consistence than natural. There is another peculiarity in this organic derangement, which distinguishes it from can cer; it is not limited to the cardia or pylorus, but affects the whole of the stomach; and, instead of being limited to a certain portion of the intestines, affects the whole intestinal canal. Upon making a section of the diseased intestines, we cut through a substance of an uniform consistence, which somewhat resembles the white part of the skin of an orange, through which a great many blood-vessels are distributed. The coats of the diseased part are rarely of an uniform thickness, being generally thicker towards the right side of the stomach, where I have seen them half an inch in thickness. In some cases, we observe small conical swellings growing from the villous coat of the stomach, and upon the same coat there are generally patches of a florid red colour; the stomach always contains a quantity of a very viscid mucus. A very peculiar species of ulceration follows the unnatural thickening of the coats of the part affected by scrofula, and which was, I believe, first described by Dr. Carmichael Smyth, in the second volume of the London Medical Communications. The size of the ulcer varies from that of a six-pence to that of a crown-piece, its form commonly circular or oval: the erosion of the villous coat is more extensive than that of the muscular; the perforation or opening through the peritoneal coat is much the smallest, and seems produced by sudden rupture. The edges of the ulcer are found well defined, somewhat thickened, rounded, and sometimes hard, a proof of its long standing. The disease is confined to the villous and muscular coats of the stomach, whereas the peritoneal is always free from disease.

The kidney is very subject to scrophulous action. Sometimes the extent of scrophulous suppuration is such that the whole substance of the gland becomes destroyed, and nothing but a bag remains. We shall pass over the section on scrophulous affections of the brain, and also that on scrophulous ophthalmia, with the exception of some short notice of Mr. Lloyd's description of the ophthalmia so long prevalent in CHRIST'S HOSPITAL.

This disease was evidently of a purulent kind, but commenced very gradually, and in both eyes at the same time. Slight inflammation of the palpebral conjunctiva ushered in the attack, attended by a sense of weakness in the eye, and a low degree of intolerantia lucis. This state would often exist for several months, though gradually increasing, till, from some accidental cause, as a cold, blow, or introduction of some foreign substance, a sudden and great increase of inflammation would take place, during which the tunica conjunctiva would become so much thickened or granulated as to form distinct folds at that part where it begins to pass from the eye to the eyelids. This stage of the disease was sometimes painful, sometimes not-and the same might be said of the sensibility to light-and of the general health. Except in bad cases, there was little acceleration of pulse, and no particular whiteness of the tongue. This stage often existed but for a few days, and seldom continued more than a fortnight, except where there was constitutional disturbance. With the cessation of the acute inflammation the third stage might be said to commence. This was distinguished by a sense of weakness in the eyes, and dimness of sight; but particularly by the immensely thickened state of the conjunctiva, and the discharge of a muco-purulent matter, which often lay in masses on the surface of the granulations, or between the folds of the diseased conjunctiva.

In the treatment of this disease, there was nothing to be done during the first stage, or when there was only an appearance of slight inflammation of the conjunctiva palpebrarum, but to wash the eyes occasionally with some soothing or very mild astringent lotion-to anoint the edges of the eye-lids with a mild ointment at bed time-to keep the bowels regular-and to avoid all sources of irritation. Our author, however, confesses that neither this nor any other treatment ever arrested the progress of the disease effectually. When the eye became once affected it went through the three stages abovementioned, "however liberally emetics, bleeding, and blisters were made use of." Much may be done to mitigate the violence of the disease, however, by judicious treatment in this and other stages of the complaint.

In the second stage, the treatment consisted in bleeding according to circumstances-blisters-tepid fomentations mild astringent ointments-purgatives. When the growth of granulations or new parts was excessive, and the eye-lids had become everted, the argenti nitras, or even the kali purum was the most efficacious application. Instead of giving much pain, as might be expected, there was generally an immediate wasting of the granulations. Care must be taken, of course, that the caustic does not come in contact with the cornea. Mr. Lloyd much prefers this mode to excision; for in the latter case, new granulations were speedily produced. In the third stage, when the inflammation has ceased, and the parts are in a quiet indolent state, the principal part of the treatment consists in the removal of the new granulations, or newly formed surface of the conjunctiva, which may be effected in three ways-first, by the mere action of the absorbents, assisted by the judicious use of stimuli -secondly, by the caustic, as was stated before-thirdly, by excision with the knife or scissors. Of these Mr. Lloyd has found the first mode the most efficacious, except in those cases where the formation of new matter had been so excessive as to produce mechanical injury. Of all stimuli he prefers the saturated solution of argenti nitras, as being the most expeditious in its effects, and least painful in operation.

We may, however, commence with it a little weaker, and gradually increase its strength. The application should be made every day, or every other day. The efficacy of this treatment is proved by the results at Christ's Hospital, where not a single unfortunate case happened among the boys, though several hundred of them were attacked by the dis ease. Not even the slightest shade of opacity remained in more than five or six cases out of that number.

After the ample analysis which we have presented of Mr. Lloyd's work, it is hardly necessary to state any opinion on its merits. We shall therefore conclude with a very laconic judgment—it deserved the prize awarded by the College.

VIII.

A System of Surgical Anatomy. Part I. On the Structure of the Groin, Pelvis, and Perineum, as connected with Inguinal and Femoral Hernia; Tying the Iliac Arteries; and the Operation of Lithotomy. Illustrated by nine copper-plate Engravings. By WILLIAM ANDERSON, Licentiate of the Royal College of Surgeons in Edinburgh, and Lecturer on Surgical Anatomy in New York. Quarto, pp. 200, with nine coloured Plates. New York, 1822.

Tros, Tyriusve nobis, nullo discrimine agetur.

In this country it must be allowed that, within the last twenty years great advances have been made in the operative part of our profession. This may be safely attributed, in the first place, to a more correct knowledge of the changes produced on the structure by morbid actions; and secondly, to a more attentive and accurate examination of those parts likely to become the seat of surgical disease, or the subject of oper

ation.

The advantages of such investigations have been well insisted on in all the writings of that late excellent surgeon and anatomist Mr. John Bell; and the successful labours of such men as Sir Astley Cooper, Burns, and Colles, in the field of surgical anatomy, can leave no doubt as to the importance of the subject. The advantage of keeping in view the ultimate object of anatomical enquiry cannot be doubted; and Mr. Colles has aptly enough observed, that otherwise "the inexperienced student, taught to regard anatomy without any references to its uses, views it only as a collection of detached and uninteresting facts, and a catalogue of barbarous and unmeaning terms."

Our brethren of the new world have not been inattentive to this most interesting and important study, and, in conse quence, many of their names adorn the records of surgery.

Mr. Anderson, it appears, has made this branch a particular object of his attention, and has been engaged, not unsuccessfully, as we may gather from the work before us, in communicating his knowledge to others. We have no doubt that, by his labours, he will, ere long, reap a rich and ample harvest. While we are thus inclined to approve of the praiseworthy intentions of the author, and generally to applaud the execution of the task, we know that he would not thank us for withholding what remarks we may have made

on some particular points; nor could we reconcile such a course to the duty we owe our brethren at large.

Our author has, in this volume, embraced the surgical anatomy of three most important operations-those for hernia, aneurism at the top of the thigh, and stone in the urinary bladder.

The anatomy of hernia has lately occupied the attention of the most eminent surgeons, as Cooper, Scarpa, Hey, &c. yet, notwithstanding the labours of these, and many others high in the profession, it remains still one of the most puzzling and confused subjects to the surgical pupil. This has arisen, we are convinced, not so much from the complicated nature of the structure, as from the confusion of terms and the endless differences in the descriptions; there is such a jumble of tendons and ligaments, straight and crooked, and sheaths and fascias, and arches, with pillars and rings, that the pupil is perfectly confounded and lost amongst them. But this is not the worst of it, for we find many different names applied to the same part, or to its subdivisions; for instance, the femoral ligament, the falciform process of the fascia lata, and the sheath of the vessels, &c. are all names applied to the same structure. Were surgeons and anatomists, by common consent, to abandon such superfluity of terms, (for when a name, however absurd, is once bestowed, it is seldom forgotten, especially by those who talk about anatomy,) a great deal of difficulty would be done away with.

From the following annunciation in the preface, we are led to expect something new on the subject of hernia.

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Upon the structure connected with hernia I have introduced an innovation, having delineated and described a crural arch, distinct from the ligament of Poupart:-this I send forth with all becoming humility, submitting the matter to the investigation of the careful anatomist, and to those who may yet have to divide the structure of a femoral hernia in the living subject. The operations upon the iliac arteries I have considered, because I feel myself prepared to recommend a more safe operation for securing them with ligature than has been pursued." Preface, p. 8.*

Of the comparative safety and success of the operations on the iliacs hereafter; the innovations in the anatomy of

*We cannot exactly understand the tendency of the following observation in the preface. Speaking of his chapter on Lithotomy, our author remarks that he " might have introduced the subject by an essay on the doctrines of Bacon," &c. Perhaps it is, that such is the practice in some of the transatlantic schools, as well as in a few of those in our own happy country. We heartily agree with our author in condemning such affectation and conceit.