easily enters the system. This causes neither griping nor purging; in a child it does not even in general cause soreness of the gums; but it cures the disease. Very few of those children ultimately recover in whom the mercury has been given internally; but I have not seen a single case in which this other method of treatment has failed." (pp. 244-5.)

We cannot take leave of Sir Benjamin, in this chapter, without thanking him very heartily for "putting in a good word" for sarsaparilla; a useful medicine, which it is too much the fashion of the present day to neglect and decry.

LECTURE XIII. "On tic-douloureux, or facial neuralgia." The uncertainty of our pathology of this lamentable ailment is well stated; in regard to those cases in which the mischief obviously depends on some disorder of the system at large, not on any local affection.

"There is something or another, somewhere or another, in the system, which acts as a source of irritation to the nerves of the face; but where that something is, and what it is, we cannot discover.” (p. 259.)

Contrary to what we apprehend is the general impression, Sir Benjamin maintains that little or no good ever follows the removal of diseased teeth.

"I never knew a case in which a patient was relieved of a genuine tic douloureux by the extraction of a tooth; and I remember in a conversation which I had with an experienced dentist some years ago, that he told me that he had very frequently been called upon to extract teeth on these occasions, and that he was not aware that the operation had been of service in any one instance." (p. 256.)

It may be so; yet we should consider it but a clumsy practice which would permit diseased and useless teeth to remain in the head of a patient afflicted with tic douloureux of the face.

As to the merits of the "operation" for tic, no one will dispute the propriety of its being placed in the following position.

"It is altogether an unscientific operation, from which we have no more right to expect benefit than we should have from the amputation of the testicle in a case of pain referred to that organ in consequence of a calculus being lodged in the ureter." (p. 261.)

In speaking of the empirical use of certain remedies, our author states that he has never known any benefit to accrue from increasing the dose of the carbonate of iron beyond a drachm thrice daily, and properly insists on the occasional administration of purgatives, to prevent accumulation of the medicine in the colon, as is otherwise apt to occur. But in regard to these, and all other quasi specifics, it is most important to remember that it by no means follows that because they are doing no good they are doing no harm. "No one can be dosed constantly with medicine without the health being ultimately injured by it; and if you have not some reasonable grounds for giving medicine, you have no right to run the risk of doing harm by its continued exhibition." (p. 265.) We are satisfied that many systems have been improperly ruined in empirical and unsuccessful attempts to purchase a local advantage at too high a cost. How often

in amaurosis, for example, has not the routine of mercury, colchicum, strychnia, bleeding, blistering, left the patient much worse than it found him? As regards new remedies, the following quotation contains a wholesome truth:

"I shall take this opportunity of observing, that I am not disposed to try indiscriminately all the new remedies which in these days are being constantly brought before society; nor can I think well of this modern fashion of resorting on all occasions to novel methods of treatment. I advise you, if you wish to succeed in your profession, and to be useful to society, to pursue a different course. Make yourselves masters of the old remedies. Learn how to handle them, and what good they will do, and, as a general rule, have recourse to them in the first instance. If the old remedies fail, and you are at a loss as to what you should do, then, and not till then, have recourse to the new ones. If you always begin with new remedies, you throw away the valuable results, not only of your own experience, but of the experience of those who have gone before you. You have to begin, as it were, de novo; and the first consequence of this will be, that will not cure you your patients; and the second, that you will have none to cure." (pp. 267-8.)

LECTURE XIV. "On fatty or adipose tumours." In some cases of lipoma, a hypertrophied condition of the integument and subcutaneous adipose tissue-not an example of the true fatty tumour-our author is of opinion that benefit is to be derived from the internal use of liquor potassæ in large doses; a drachm, thrice daily in small beer.

The next six chapters treat of mortification. They are, for the most part, quite elementary in their character; but the following points are more suited for especial notice:

"Another plan may be adopted to prevent mortification from pressure; that is, to prevent the inflammation which precedes it. The thicker the cuticle the more it will protect the parts beneath; you may, if you attend to it in time, add to the thickness of the cuticle by stimulating the surface of the skin. Nurses know this very well, for when patients are bed-ridden they wash the parts subjected to pressure with brandy. What is still better is a lotion composed of two grains of bichloride of mercury to an ounce of proof spirits. When you think that a patient is likely to be confined so long in bed that sloughs may be formed on the os sacrum, begin at an early period to wash the parts two or three times a day with this lotion. I have found it useful in other cases where a patient suffers from pressure. For example, in a case of hernia, which requires to be supported by a very powerful truss; the truss galls and frets the skin, and may at last cause inflammation and sloughing; but under the use of a stimulating lotion a thicker cuticle is generated, and such mischief is avoided." (pp. 311-12.)

"Almost always, when you use a caustic, it is prudent to have some counteragent at hand to stop its action if it reaches a sound part. Acids may be neutralized by alkalies; caustic potash may be neutralized by vinegar, or by a solution of the diacetate of lead. If you are afraid of nitrate of silver burning the neigh bouring parts, its action may be neutralized by common olive oil. A solution of bicarbonate of potash will decompose chloride of zinc, and so with other caustics." (pp. 328-9)

Subcutaneous nævi may be destroyed by the subcutaneous puncture of a knife, freely lacerating the morbid structure, followed by a probe dipped into nitrate of silver, melted in a platina or silver spoon. The advantage of such a procedure is, that when the nævus is situate on the face, it may be removed effectually thus, without having any cicatrix or other deformity. The operation "causes inflammation and sloughing, at the same time obliterating the vessels beyond the margin of the slough."

Is our author certain that the following is a fact?

"The fact is, that a wound always heals much more readily after the application of caustic, than after the use of the knife. Take two cases: if you destroy one

tumour of a given size by the knife, and the other, supposed to be of the same size, by caustic, in spite of the time occupied by the separation of the slough, the sore in the latter case will be healed sooner than that in the former." (p. 334.) We think we could get up a good deal of evidence to the contrary. In applying caustics to the scalp, observe caution. Extensive destruction of the pericranium may cause necrosis of the corresponding portion of the skull, throughout its entire thickness; this is likely to be associated with purulent detachment of the dura mater, and from that a train of fatal symptoms may arise. Our author has seen this unfortunate sequence. Chloride of zinc is not a suitable escharotic for soft parts, unless a raw surface previously exist. When applied to the unbroken skin it produces intense pain, and fails of the escharotic result.

Most cordially do we agree with the following. There are a few cases certainly, which we need not here stop to specify, in which the actual cautery is preferable to caustics; but only a few. Of late years we were much afraid that a retrograding tide had set in in favour of the "rude piece of farriery ;" but for some time back we have been charmed to find such fears gradually subsiding, the cauteries having again resumed their little disturbed position in the armamentarium.

"The actual cautery does nothing which caustics would not do as well or better, and it is much more alarming and frightful, both to the patient and to bystanders. It was the habit of surgeons here, fifty or sixty years ago, to use the actual cautery to a great extent; and it appears to be one of the many proofs of the advancement of English surgery that we have got rid of what Sir Astley Cooper used to call ‘a rude piece of farriery.'" (p. 345.)

LECTURE XIX, "On senile gangrene," we could have wished expunged. The description contains nothing new, and some of the treatment is, in our humble opinion, both old and bad. Our readers need not to be told that the animal-food and port-wine system is not that which, in a large proportion of such cases, ought to be recommended.

LECTURE XXI. "On chronic abscess of the tibia." Here Sir Benjamin is peculiarly at home. The profession is undeniably indebted to him for a large boon, in having determined the existence of this formidable disease, and the simple and satisfactory means whereby it may be remedied. The affection is most liable to occur in the tibia, at either extremity, but most frequently at the upper. In 1824, the first case occurred to our author; but unfortunately its true nature was not discovered till after amputation. In 1827, a second patient appeared; and, being subjected to the suitable treatment, retained his limb, and was rid only of the disease. Since then it must indeed be very satisfactory to Sir Benjamin

"to know that this simple method of treatment has already preserved many limbs which must have been sacrificed otherwise, and it cannot be doubted that it will be the means of preserving many more, when it is generally adopted by those who are engaged in operative surgery." (p. 403.)

A trephine of less size than what is ordinarily used for the skull is generally sufficient; and it should have no projecting rim or shoulder, so as to permit of deep penetration. The circumstances which point to the operation are the following:

"When the tibia is enlarged from a deposit of bone externally-when there is excessive pain, such as may be supposed to depend on extreme tension, the pain

being aggravated at intervals, and these symptoms continue and become still further aggravated, not yielding to medicines, or other treatment that may be had recourse to, then you may reasonably suspect the existence of abscess in the centre of the bone. You are not to suppose that there is no abscess because the pain is not constant; on the contrary, it very often comes on only at intervals, and in one of the cases which I have related there was, as I then mentioned, an actual intermission of seven or eight months. After the disease has existed a certain number of years, indeed, the pain never entirely subsides, but still it varies, and there are always periods of abatement and of exacerbation.” (p. 404.) Our last quotation is from the preface.

"If what I now offer to their perusal should prove acceptable to the profession, I may venture to publish a Second Series of my Lectures, as soon as I find the necessary leisure for that purpose." (p. iii.)

We venture to say that the profession will gladly take Sir Benjamin at his word. But if we may be allowed, we would throw out a hint for his consideration in regard to the next volume; namely, the propriety of not giving us the lectures exactly as they were delivered; but holding back the elementary, the well-known, and-even though good-the stale,giving prominence and bulk to his own views and practice when varying from the ordinary routine, and bringing all up quite to the level of modern scientific advancement.

ART. XIV.

The Structure and Functions of the Female Breast, as they relate to its Health, Derangement, and Disease. By E. W. TUSON, F.R.S., Surgeon to the Middlesex Hospital.-London, 1846. 8vo, pp. 485.

THE earliest impression produced by this book is, that—

Has taken up arms against English and Grammar;"

and it is an impression no less enduring (scarcely a page fails to give it fresh distinctness) than it is early. The preface introduces sundry examples of the belligerent propensities of Mr. Tuson against the parts of speech; and to illustrate these, as well as to give the reader some inkling of the aims and qualifications of this anti-grammatical warrior, we shall examine the contents of the said preface more closely than is our wont.

The book was, we learn, " compiled during those hours which could be spared from professional engagements, both in public and private practice,"—an intimation which might be regarded merely as a satisfactory indication of the marvellous extent of Mr. Tuson's practice, did it not serve to introduce a very remarkable apology for all the deficiencies of the subsequent pages. The practice caused interruptions, "which on some occasions broke the chain of reasoning already commenced, and perhaps may have prevented the same line of argument being continued; so that should the reader find any defect in this respect, he must attribute it to this cause." Certainly, to this cause we shall invariably ascribe the contradictions, the total absence of reasoning power, nay, the want of common sequence of ideas, which throw a certain veil of obscurity over what would otherwise doubtless prove a mass of living light. Mr. Tuson's

faculties were money-gathering; people, too, would not let him alone, and each absurdity he has put to paper is but an indirect proof of his social and intellectual greatness. And yet with touching modesty Mr. Tuson apologises for trespassing on public indulgence with this his seventh book. Let him take heart,-when individuals of his mental caliber condescend to produce books, what right have poor devils, like ourselves, to be nice? They may, it is true, be "prevented from continuing the same line of argument;" but what is our business, but to establish the missing nexus, and exult that we are permitted to exercise our intellects upon matter so profound? And Mr. Tuson talks so humbly of his early productions-his waistcoat-pocket Remembrancers, &c.—that our very hearts yearn towards a man so modest and yet so great. True, we do remember to have heard it said, there was a wondrous adaptation of the bulk of the said productions to the capacity of the intellect producing them, but for our parts we always saw in such observations naught but envy and malice. And does not the event justify us? Here is a book "as big as the best of them;" nor does its character allow the reader for a moment to imagine that Mr. Tuson has given the world one more illustration of the immortal fable of the Frog and the Bull.

Mr. Tuson's opportunities of observing have, he tells us, been great; but he feels "little satisfaction with the progress made in such a number of years." He has, however, " of late been more than particularly active [he was always, as is well known, particularly active] in his researches, and feels a greater gratification in having accomplished much more in a shorter space of time.” Of course; all Mr.Tuson has to do at any time is to take to a subject in earnest, and he must do wonders; in the present instance he has kept the disclosure of the wonders for, we suppose, the "second edition ;" and if we cannot have them just at the moment, it is well to know that they are to appear in futuro.

In page x Mr. Tuson discourseth in the following wise, "the brain and spinal marrow have entering into their formation certain acids and products which are not present in other structures, and which are perfectly distinct from other animal tissues." There are several (doubtless valuable, though to our limited comprehension somewhat obscure) scraps of information contained in this sentence. We learn, for example, that "certain acids" are "animal tissues," and yet further, that these "certain acids" are "perfectly distinct from other animal tissues." We have worked at this till our brain has reeled, and yet fathom its entire depth we cannot. It is indeed clear there is a lapsus somewhere, and we would venture to suggest that Mr. Tuson was "called to a case at the words “certain acids," and was thereby unfortunately "prevented from continuing the same line of argument." That no effort of his could ever recall the profound train of thought, in which he had obviously launched, when he reached the words "certain acids," is not in the remotest degree strange. Your twelve-and-sixpenny Dutch clock may be shaken and shaken, and put out of sorts in all manner of ways, and yet on it goes still;-but your finely and delicately organized repeater must be more gently treated,misuse it, and its train of action cannot be coaxed back into regularity. Need we say that Mr. Tuson's mind is among minds what the most precious of repeaters is among time-pieces?