780 
Arxtr. XLVIIIL Practical Observations in 
utam Hey, L£sq. F. R.S. Member of 
MEDICINE, SURGERY, ANATOMY, &e. 
Surgery, illustrated with Cases. By Wit« 
the Royal College of Surgeons in London ; 
honorary Member of the Royal Medical Society of Edinburgh, and of the Literary and 
Philosophical Socicty of Manchester; and senior Surgeon of the General Infirmary at 
Leeds. 
_ THE abilities and experience of the 
ingenious author of this work have al- 
ready gained him considerable celebrity, 
and the publication now before us will 
be found to possess those claims to at- 
tentive consideration, which are derived 
from accurate observation, sound judg- 
ment, and a perspicuous detail of in- 
teresting facts. 
The first chapter is on fractures of 
the skull. In this, the author combats 
the practice pursued by Mr. Pott, that 
of taking away part of *the integuments, 
to give room for examining the state of 
the skull. It is always sufficient to make 
an incision for this purpose, and to have 
the mteguments held back while the ex- 
amination is pursued. The author is of 
opinion that there are various inconve- 
miences attending the employment of the 
trephine, for the purpose of removing 
such parts of the skull as may be in- 
jured, and therefore recommends the use 
of a saw, which may be worked gently 
in a straight or curvilinear direction, 
Saws of this kind he has used fora great 
number of -years, and finds that much 
less of the cranium is obliged to be re- 
moved when they are employed, than 
must be done in the usual manner of 
operation. 
In a case of caries in the tibia, the vi- 
tiated bone was successfully removed by 
the saw now mentioned, and in another 
ease, when the posterior tibial artery 
was wounded, the removal of a portion 
of the fibula allowed the artery to be got 
at, and taken up. 
Chapter 2d. On the Cataract.—The 
author informs us, that he cannot enter 
jnto a fair comparison between the ope- 
ration of couching and that of extrac- 
tion, because he has only performed the 
latter operation once, and then, though 
he did it with a great deal of care, the 
inferior half of the cornea became opake, 
so as to deprive his patient of the benefit 
of the operation. Couching he has been 
in the habit of performing for thirty- 
three years, -and with so extensive an 
experience of its merits has not been 
able to find it liable to any of the ob- 
jections made against it by Baron Wen- 
zel. He prefers a round needle ‘flat, 
tened near the point to the spear-pointed 
8vo. pp. 537. 
one generally in use. Several cases are 
given in which this operation was per- 
formed, and one is mentioned, where, 
from the unsteadiness of the patient, and 
the power which was possessed of draw- 
ing in the eye, he could not succeed in 
depressing the cataract; but the mere 
passing a needle through it, answered 
the purpose of producing its gradual 
absorption, and of thus restoring the 
_ sight of the patient. 
Chap. 3d. On the strangulated Her- 
nia.—Much difference of opinion has 
taken place on the propriety of blood- 
letting in this disease. ‘The author is 
inclined to conclude, that there are cases 
in which this remedy may be useful, and 
others in which it will prove pernicious. 
Bleeding has generally failed in pro- 
ducing a reduction of the gut, but it has 
never (as Mr. Wilmer supposes), with- 
in the author’s knowledge, rendered the 
subsequent operation more dangerous. 
Purgative medicines by the mouth ara 
condemned, glysters have been of little 
service, the warn bath has not uniformly 
done good. 
*€ Gentle efforts with the hand to reduce 
the prolapsed part are perhaps attended with 
less danger, aod with greater prospect of suc- 
cess, while the patient lies in the path, than 
in any other position. The free use of opiates 
coincides with that of warm bathing, and, 
under some circumstances, these means de- 
serve to be tried in conjunction.” 
Opiates are not in general successful 
in producing a reduction of the intestines, 
but they are useful in mitigating the 
symptoms, when it is necessary to re- 
move the patient to a considerable dis, 
tance. Cold stupes, and the cold bath, 
have oftener failed than been service- 
able. Injections, a decoction of tobacco 
(made by$ boiling a drachm of the cut 
leaves for ten minutes ina pint of water), 
are, upon the whole, considered as the 
most efhcacious remedies in the stran- 
gulated hernia, previous to the operation. 
The author is decidedly of opinion, 
that the operation should be performed 
early, to give it a chance of success, 
When he first began business, he lost 
three patients in five, on whom the ope- 
ration was performed, trom delaying ig 
too long. ane 
