BIBLIOGRAPHICAL NOTICES.
A Practical Treatise on the Diseases of Children, by J. Forsyth
Meigs, M. D., Lecturer on the Practice of Medicine in the
Philadelphia Medical Association, etc., etc. Second Edition,
Revised and Enlarged. Philadelphia, Lindsay & Blakiston,
1853. pp. 711.
This work is a republication, with considerable additions and
modifications, of one of the series of “ The Medical Practitioner’s
and Student’s Library.” The original edition having been ex-
hausted for some time, a second has now been brought before
the profession as a separate and distinct treatise. The addi-
tions consist of an Introductory Essay on the Clinical Exami-
nation of Children, and an article on Atelectasis Pulmonum,
or imperfect expansion of the lungs. The articles on Croup,
Bronchitis, Pneumonia and Scarlet Fever, have been entirely
re-arranged and in many parts re-written; that on Measles
has been much added to; and the subject of Tracheotomy in
Croup has been discussed at considerable length.
The essay on the clinical examination of children is a very
proper, we might almost say, a necessary introduction to a work
of this kind. The diagnosis of infantile affections is replete
with difficulties to the young practitioner, and these can never
be overcome unless he knows what to observe and how to con-
duct his examination. The whole article will repay a careful
perusal. We would particularly commend to the reader’s atten-
tion, the passages under the head of “The Cry,” and “The
state of the cutaneous surface,” as containing much valuable in-
formation. It is evident that Dr. Meigs has paid great attention
to the subject of Semeiology. His Essay is not a mere digest
of the opinions of authoritative writers upon the subject, but is
replete throughout with remarks which show accurate and care-
ful observation.
No physician of the present day should be ignorant of the im-
portant part, Atelectasis plays in the diseases of children. Its
frequent occurrence in early childhood from various causes, and
its connexion with Catarrh and Bronchitis, are admitted by all
who have studied the subject. Dr. Meigs makes two divisions
of the affection. 1. Congenital Atelectasis, in which larger or
smaller portions of the lung have never been penetrated by the
air : a continuation, in fact, of the foetal condition; and 2d,
Collapse of the lung or post-natal Atelectasis. As a sample of
his mode of treating the subject, we extract the following ;
“ When, as indeed, most usually happens, collapse occurs in the course
of bronchitis, it is associated of course with the symptoms of that disease.
The bronchitic symptoms have lasted in their usual form for several days,
having been marked by sonorous, sibilant, and subcrepitant rales, when
suddenly, or in the space of a few hours, the breathing becomes much
worse, the pulse rises in frequency but becomes small and feeble, and
certain changes take place in the physical signs which are very impor-
tant. The subcrepitant rale continues to be heard, but it is associated
now with prolonged expiration, and a little later with bronchial respira-
tion, which, however, is of a different kind from the bronchial respiration
of pneumonia, being distant and smothered, instead of near and metallic,
as in that disease. The percussion becomes at the same time, dull and
obscure, but never, scarcely, to the same extent as in pneumonia. The
general symptoms are those of exhaustion, rather than of high reaction.
The surface is pale or slightly bluish, the skin is either natural, slightly
warmer than usual, or coolish, the strength is very much reduced, and
the child appears more seriously ill, and particularly more oppressed
often than the amount of bronchitis present would seem to explain.”
The causes, symptoms and anatomical appearances of both
forms of the affection are described with great fullness and pre-
cision. In the treatment of collapse, he recommends warmth,
nutritious diet, the use of mild stimulants and tonics, and the
external application of revellents. When it occurs in the course
or towards the termination of severe bronchitis, in addition to the
above, he advises the application of dry cups or mustard poultices
to the chest, and the use of emetics two or three times daily,
unless they are found too exhausting. Electricity and insuffla-
tion of the lungs are not mentioned. In regard to the latter,
MM. Rilliet and Barthez state that it is difficult to imagine that
it can be hurtful in Atelectasis. They state their belief also,
founded on Joerg’s experiments, that carefully used in the first
few days of the disease and following the inspiratory movements,
it would be able to restore the lung to its normal condition. In
the paroxysmal form of the disease, where other means had been
used unsuccessfully, we should think it well worthy of a trial.
Dr. Meigs fully adopts the views of MM. Legendre and Bailly,
regarding the nature of what was formerly termed lobular pneu-
monia. Their researches, with those of Dr. Gairdner, and his
own investigations of the subject, have convinced him that in the
great majority of cases, the affection in question was bronchitis
complicated with collapse of the lung and not inflammation of the
pulmonary parenchyma.
In relation to the views held by writers previously to the dis-
covery of the true pathology of this disease, he says:
“The peculiar character of the lesions met with in many of the sup-
posed cases of pneumonia, had often drawn attention and been com-
mented upon, before their real nature came to be understood. The points
of difference between these alterations and those of true pneumonia, were
particularly noticed by MM. Denis, De La Berge, Rufz, and MM. Ril-
liet and Barthez, and Dr. West. In fact, M. Rufz, and MM. Rilliet
and Barthez, both approached very near the truth in regard to these
lesions, each comparing them, but the former at an earlier period than
the latter, to the condition of the lung of a foetus that has never breath-
ed. The latter writers, in their article on pneumonia, have described a
condition of the lung which differed so much from ordinary pneumonia, as
to create a great difficulty in their minds as to its true nature, and to it they
applied the term carnification. They were on the very verge of detecting its
real character; they did in fact suggest its real character, but were so pos-
sessed with the idea that it must be the result of some inflammatory action,
as to neglect to pursue their own suggestion, but endeavored to explain
the condition on the ground that it was ‘ one mode of termination of
pneumonia or else chronic pneumonia.’ The following passage, quoted
from their work ( T. 1, p. 74), will show how closely they approached
the truth : ‘ The first idea that enters the mind on examining this tissue
(carnification), is, that it resembles the lung of a foetus that has not
breathed; we should feel inclined to say that the pulmonary vesicles had
not yet been dilated under the influence of the thoracic expansion, and
had not, therefore admitted air into their interior, or rather, it would
seem as though they had been obliterated by some attack of disease, per-
haps inflammation, without, however, remaining engorged, and after
having lost the power of dilatation.’ ”
We regret that he makes no mention here of Dr. Gerhard’s
valuable paper on the pneumonia of children, published in 1834,
in the American Journal of the Medical Sciences. This, be it
remembered, was four years previous to the issue of the treatise
of MM. Rilliet and Barthez. In that paper, second series, Dr.
Gerhard accurately analyzed the symptoms, physical signs, and
anatomical appearances of twelve cases, occurring in children
between two and six years of age, of what he then styled pneu-
monia, but which were, without doubt, cases of bronchitis com-
bined with collapse of the lung. The results he obtained were
highly interesting and unexpected. The essential nature and
cause of the lesion found in every instance, and to which he
gave the name of lobular induration, were evidently no more under-
stood by him than was carnification by MM. Rilliet and Barthez.
It is now known that Dr. Gerhard was too exclusive in his re-
striction to children above six years of age, of pneumonia, as
it is found in adults. With this reservation, his paper, by far
the best of its time, may be consulted even now with advantage.
Of Pneumonia, Dr. Meigs makes two divisions, lobar and
partial, preferring the latter term to that of lobular for obvious
reasons. During the last four years he has observed 37 cases.
Of these 33 were primary and 4 secondary; 19 occurred in
children under five years of age; 18 between five and eleven
years. In two cases there wTas double pneumonia, unilateral
in all the others; 13 had the upper lobe affected, and 20 the
base; of 50 cases, 37 of which were observed during the last
four years, two died. The treatment is the same as that given
in the first edition.
The subject of Scarlet Fever seems to be a favorite with Dr.
Meigs, as he has devoted sixty-four pages to its consideration.
He discards, we think without good reason, the old distinctions
of simple, anginose and malignant, and substitutes for them
the terms mild and grave, according to the severity of the dis-
ease. Of the former, mild, he has had 144 cases ; of the grave
41, of whom 23, or 57 p. ct, died. The whole subject of scarlet
fever, its complication, sequelae, and treatment are fully and
elaborately discussed.
In closing our brief notice of Dr. Meigs’ work, we have great
pleasure in bearing testimony to its high merit, and especially to
the improvements introduced into the present edition. There is
certainly, now, no work in the language in which the leading
diseases of children are more agreeably, clearly, and faithfully
delineated. And, in expressing our regret that some affections
peculiar to childhood, have been unnoticed, we feel bound to
admit the force of the author’s apology for the subjects un-
touched—“the want of time and opportunity to make use of the
materials he has collected.” In a succeeding edition, “he hopes
and expects to fill up the omissions of the present oneand we
have little doubt that the fulfilment of this pledge will be called
for at an early day.
Practical Observations on Aural Surgery and the Nature and
Treatment of Diseases of the Ear. With Illustrations. By
William R. Wilde, Fellow of the Royal College of Surgeons
i in Ireland, Surgeon to St. Mark’s Ophthalmic Hospical, etc.,
etc. Philadelphia : Blanchard & Lea, 1853, pp. (with In-
dex,) 475.
Of this valuable monograph we may most unhesitatingly say,
in the language of the American editor, “ that it will fill a void
in our medical literature which has long been felt, and which no
work published in this country has ever been adequate to fill.”
Aural Surgery has, indeed, as the author well observes, been
long encompassed with a shroud of quackery, medical as well as
popular; and we hail, with no ordinary satisfaction, the appear-
ance of a work, in which a successful attempt has been made,
“ to lay down just principles for an accurate diagnosis of Diseases
of the Ear; to rescue their treatment from empiricism, and found
it upon the well established laws of modern pathology, practical
surgery, and reasonable therapeutics.”
The qualifications of Mr. Wilde for the proper discharge of the
task which he undertook in the Treatise before us, are thus
graphically portrayed by his friend and former pupil, the Ame-
rican editor, Dr. Addinell Hewson :
“ Possessed of extraordinarily quick perceptive faculties, highly culti-
vated by early discipline and use, of mature judgment and consummate
skill, of untiring zeal and industry, and of high literary attainments,
few surgeons have had better opportunities, or could have made better
use of them, than Mr. Wilde. St. Mark’s Hospital for Diseases of the
Eye and Ear, the field of his public labors in these branches, is an in-
stitution of his own creating, which has been in operation nearly ten
years, and is now one of the largest and best conducted of the kind in
Great Britain. All those who have had the good fortune of attending
his clinics, and observing his practice there, will willingly bear testimony
to their admiration of his talents.”
We should be glad to be able to quote at length Mr. Wilde’s
forcible allusions, in his Introductory chapter, to the reprehensible
neglect with which the subject of aural diseases has so long been
treated by medical men. Our management of this class of affec-
tions has, indeed, been characterized by an empiricism, of which
we should feel heartily ashamed in prescribing for the lesions of
other organs of the body. We have been content, (as Mr.
Wilde remarks, with a justness which we are satisfied our readers
will generally acknowledge,) “theoretically to believe, and
practically to observe, that we know nothing about the diseases
of the organs of hearing.” And we fear, that but too many of
us must recognize a faithful portraiture in his witty description
of the ordinary routine of practice in such cases:
“ First syringing with hot water and soap, either Castile, soft, yel-
low, or old brown Windsor, in the hope that the deafness or noise in the
ears might arise from a collection of hardened wax;—then setting the
digestive organs to rights by purgation, and 1 a course of bitters/ lest
the affection might be ‘owing to the stomach?............“ Next in
order, blistering behind the ears is tried, in order to draw away some
pecqant humor, that had, perhaps, accumulated round the delicate or-
gan of hearing. These and such like methods failing to give relief,
stimulants, often of a very acrid nature, are poured into the external au-
ditory passages, either to restore the reaction,-—under the impression
that what is a mere attending symptom is the disease,—or to excite or
rouse the dormant nervous power; and hot tinctures, turpentine, crea-
sote, and pungent essential oils, are applied to the external surface of the
tympanal membrane without mercy. Some practitioners resort to more
palliative means, recommending warm almond oil to be dropped into the
ear at bed time, or eau de Cologne to be rubbed upon the side of the
cheek adjoining the auricle, at the same time advising a little black
wool to be retained in the meatus, in order to preserve the organ free
from cold. To give, however, fair play to the latter remedy, it should
be prescribed in full, and according to the old popular superstition, but
one which is still extensively resorted to,—the wool should be procured
from the left fore-foot of a six years’ old black ram I Some advise a slice of
fat bacon to be inserted into the meatus every second night ; and gly-
cerine is now the fashionable remedy. All these means having failed to
give relief, the patient is frequently recommended—an easy mode of get-
ting rid of him—to give galvanism and electricity a fair trial; and if they
do not succeed, change of air and scene, sea-bathing, or a ‘ course of
waters’ at some of the fashionable places of resort for that purpose is
prescribed. Despairing of relief from the legalized practitioner, and get-
ting disheartening opinions from men of eminence and repute, we need
not wonder that suffering patients throw themselves into the hands of
quacks and nostrum-mongers.”
Mr. Wilde’s First Chapter is occupied with an extended and
very interesting Bibliography of aural surgery. Among modern
investigators he particularizes Mr. Toynbee as entitled to the
first place.
“ The labors and investigations of Mr. Toynbee have effected more for
aural pathology than those of all his predecessors either in England or
on the Continent. He commenced at the right end, and has travelled in
the proper direction. He has brought to bear upon the subject the true
principles of science, and with the assistance of the microscope,—the aid
of every modern artistic appliance to assist him,—accustomed to habits
of minute dissection, patient research, and careful observation,—he has
accumulated a mass of facts upon the morbid anatomy of the organs of
hearing that must lay the foundation for a more rational mode of treat-
ing the diseases of those parts than has heretofore been resorted to.
Mr. Toynbee has already recorded the results of the dissection of the
ears of about 750 persons sent to him for examination, but of which
number not more than sixty or seventy were from persons the history of
whose deafness was known.
Mr. Toynbee has labored extensively, and with effect, to discover and
describe the post mortem appearances which disease has produced in the or-
gan of hearing; and I trust he will long continue to prosecute, with the same
avidity, the same honesty of purpose, and an equal amount of critical acu-
men, his valuable researches. Morbid anatomy, however, is one thing—
pathology another. The dead subject upon the dissecting-table teaches
the student not disease, but the results of disease. It avails little that
the hospital pupil should have pointed out to him, in the dead-room, the
violence which sudden accidents may have caused, or the ravages which
slow disease has produced in the various organs or textures of the body;
it matters not to what extent the microscope may exhibit the wide-spread
lesion, or chemical tests disclose morbid products, unless the cases have
been observed during life, and the progress of disease previously noted
at the bedside. Therefore it is that the School of Vienna,—where a
dozen bodies from different parts of the Great Hospital, but the histories
of which are unknown, are sometimes cut up, and their post mortem ap-
pearances displayed in the lecture-room on a morning,—may, under the
able teaching of Rokitansky, Engel, and others, teach morbid anatomy
(pathology so called), but does not produce many practical physicians.
Mr. Toynbee’s researches prove the position which I long ago advan-
ced, and which from year to year I have been in the habit, not only of
teaching theoretically, but practically demonstrating in my clinical lec-
ture^—that the great majority of diseases of the ear producing deafness
have their origin in inflammation of one kind or another, Every day’s
experience confirms me in this opinion; and the cases which I now pub-
lish, will, I think, corroborate that view of the subject. Mr. Toynbee
has not yet published any separate work upon the ear, but has contribu-
ted his observations on the Anatomy, Pathology, and Treatment of the
Organs of Hearing to the different societies, and also to the periodicals
of London. Among the latter may be mentioned chiefly, the Philoso-
phical and Medico-Chirurgical Transactions, from 1843 until the present
date. He has also written several valuable papers in the Medical
Times, Lancet, Provincial Journal, and Edinburgh Medical Journal.”
A considerable space in the Bibliography chapter is devoted
to the “ Glycerine Cure," which Mr. AVilde considers as very
much of a humbug. And immediately following his exposure of
the worthlessness of this fashionable remedy, we find some ap-
parently well-merited strictures on a charlatanism which has had
some run in England, viz., Dr. Turnbull’s cure of deafness by
the application of veratria to the external meatus and the parts
joining the auricle. Mr. Wilde’s manly tone on the subject of
the aural quackery of the day, within the ranks of the profession,
is highly commendable.
Chapter II. relates to The Means of Diagnosis. In exploring
or operating upon the external auditory passages, we find that
he employs the twiwZar specula of Gruber, of Vienna, which are
merely “ conical silver tubes of different calibres, an inch and a
half long, five-eighths of an inch wide at the greater aperture,
and varying from two to four lines in the clear at the smaller
extremity.” In using the specula, he prefers direct sun-light to
all artificial illumination, and discards all the instruments with
prisms, lamps, &c., as unnecessary. Attempts to dilate the
auditory passage by means of instruments, Mr. Wilde justly
characterizes as “ showing a want of anatomical knowledge in
their inventors, for the most any speculum can effect is to
straighten the external cartilaginous portion of the tube, and
thereby allow the light to play upon the interior.”
In connection with the subject of Eustachian catheter ism, Mr.
Wilde (after describing the instrument which he is in the habit
of using, and the mode of applying it,) holds the following cau-
tionary language :
“ I know few subjects upon which there is more general ignorance than
the value to be attached to Eustachian catheterism, or the best mode of
employing it. Some writers would lead us to suppose that this opera-
tion is of use in a far greater number of aural diseases than, according to
my experience, is the fact. In order to facilitate our diagnosis, they
would have us explore the middle ear by the air douche, a jet of water,
or a solid instrument, in almost every case that presents. Errors of
commission are, in both medicine and surgery, I believe, of much
greater injury than those of omission ; and the introduction of a foreign
body into the Eustachian tube, forcing a volume of cold air, or injecting
a quantity of fluid, even warm water, into the cavity of the middle ear,
as some recommend and say they practise, is in nearly all cases, while
inflammatory action is going forward in the parts submitted to the pro-
cess, unnecessary and frequently injurious. Again, the mode in which
I have heard both patients and bystanders speak of instruments—cat he-
ters of various kinds, gum-elastic, and metallic, and even solid sounds,
some of the latter much larger than the bore of the aural end of the
Eustachian tube even in the dry bone—being introduced into the middle
ear, in order to explore that cavity, to wash out its contents, or to break
up collections of mucus within it, or to dilate strictures and contractions
of the tube itself, convinces me that the desired object was not, fortu-
nately for the sufferers, obtained. Even Kramer speaks of pushing a
catgut bougie, introduced through the Eustachian tube, “ between the
handle of the malleus and the incus People are, however, beginning
to find that this attempt—for I know in many cases it is only an at-
tempt—to force solid or fluid substances into the cavity of the drum, is
as ineffectual to remove deafness as the almost indiscriminate excision
of the tonsils—since preserved in pickle-pots—recommended for a like
purpose a few years ago, has proved to be. I have heard of cases in
which the middle ear has been said to be explored by such mechanical
means, even in this country, and I have been shown steel sounds manu-
factured for the purpose. Such instruments are, however, with the ex-
ception of the tearing and inflammation which they may cause in the
nasal extremity of the tube, harmless, for they could not by any possi-
bility, even in the dead subject, be passed through the upper end of the
Eustachian tube. We should bear this rule ever in remembrance be-
fore exploring the middle oar; it is one which Sir A. Cooper observed to
me many years ago, and I have ever since acted upon it:—Whenever
the patient is himself able to inflate the tympanum, never use any artifi-
cial means to do so; it is unnecessary and maybe injurious. Let me to
this aphorism add another, to which I have already alluded, and which
surgeons would do well to remember. Where there is reason to believe
that the cavity of the drum is inflamed, carefully abstain from all poking
with catheters, or any attempt to introduce foreign substances into that
delicately-organized portion of the animal machine. As good general
surgery teaches us to avoid the introduction of instruments through an
inflamed urethra, or into an irritable bladder, so ought judicious aural
surgery to teach us to abstain from meddling in the cases to which 1 have
alluded. The only solid instrument with which I now ever venture to
explore the Eustachian passage, and that only for a short distance, is an
ivory bougie, rendered flexible by having the earthy matter removed by
immersion in acid, and the point of which for an inch at least had been
previously softened in water so as to resemble a piece of gelatine. A
large size catheter should be first introduced, and the bougie passed up
through it; but stricture of the Eustachian tube is so exceeding rare,
and so difficult to recognize during life, that the surgeon is very seldom
called on to practise such an operation.”
Chapter III. is devoted to Statistics and Nosology of Ear
Diseases. The author here takes the opportunity, in alluding to
Kramer’s statistical chart and tables on this subject, to express
the most unqualified disbelief in the “ nervous deafness,” to
which the Berlin aurist attributes more than half his cases. He
contrasts the results of his own observations, “ faithfully taken
as they presented at a public hospital, in the presence of, and
equally observed by, a number of medical men and intelligent
students,” with the figures afforded by Dr. Kramer. And, while
not denying the great prevalence of nervous deafness, he doubts
decidedly the proportion which, according to the German aurist’s
belief, they bear to the entire mass of diseases of the organ of
hearing.
The remainder of the book is of a practical character, and
the subjects discussed are in the following order:—1. Dis-
eases of the Auricle, Mastoid Region, and External Meatus.
2. Diseases of the Membrana Tympani. 3. Diseases of the
Middle Ear and Eustachian Tube. 4. Diseases of the External
Ear. 5. Otorrhoea. We may particularize here as points
treated with especial interest, the management of strumous my-
ringitis, (p. 263)—that of accidental perforation of the membrana
tympani, (p. 287)—the discussion of the operation of extirpation
of the tonsils, (which Mr. Wilde condemns,) (p. 351)—and of the
subject of nervous deafness, (p. 361).
In the Appendix, the subject of Deaf-Dumbness is noticed at
considerable length, and will well repay perusal. The author
does full justice to the efforts of our country in this direction.
We quote his remarks with great pleasure :
“We now turn to America, where the claims of the deaf and dumb have
not only met with a hearty response from the public, but where the
country at large has made ample provision for their maintenance and in-
struction. So early as 1793 there appeared in the Transactions of the
American Philosophical Society, ‘ Cadmus, or, a Treatise on the Ele-
ments of Written Language, and with an Essay on the Mode of Teaching
the Deaf or Surd, and, consequently, Dumb to speak.’ As I have already
mentioned, the number of instances in which national institutions have
had their origin in the interest awakened in some philanthropic indivi-
dual by a mute child, is remarkable. In 1807, the deaf and dumb
daughter of Dr. Cogswell, of Hartford, U. S., attracted the attention
and enlisted the sympathies of the late Rev. Thomas H. Gallaudet,—
a man who united the true principles of charity with distinguished
scholarship and unwearied assiduity and patience. He subsequently
proceeded to Europe, in order to acquire the art of imparting instruction
to the deaf and dumb ; and having remained for some time a pupil under
the Abbe Sicard, he returned to America, accompanied by M. Clerc,
who was then (in connexion with Massieu, the favorite pupil of
De l’Epee) one of the mute assistants of the Parisian institution.
The first institution for the instruction of deaf mutes in America was
opened at Hartford in 1817. Since then, no less than twelve other
large establishments for a similar purpose have been erected in that
country; and the expenses in these are defrayed, like most of those
on the Continent of Europe, by a state provision, either in grants of
land or money.
The subject of muteism generally, as well as the system of instruction
in America, has engaged the attention of the learned and benevolent,
and the publications relating to muteism which issue from the press in
that country are numerous and valuable. The reports which emanate
from the American Institutions, particularly that at New York, are
models of their kind. The Rev. W. Gallaudet published some Sermons
on muteism, a ‘Child’s Picture, Defining and Reading Book’ (Hart-
ford, 1830,) and also some reviews and literary articles relating to the
deaf and dumb. Several interesting addresses on that subject have
been also delivered on special occasions by Laurent Clerc, Dr. Mitchell,
Mr. Lewis Weld, and Harvey Peet. These were subsequently pub-
lished, and contain most valuable information. Mr. Peet has also writ-
ten several school-books and elementary works for the deaf and dumb ;
and to the courtesy of that gentleman I am largely indebted for much
information regarding the American institutions, and for an extensive
collection of American works relating to muteism. The North American
Review for 1834 has a philosophical and admirably written article upon
the education of the deaf and dumb, and the Philadelphia edition of the
Encyclopaedia Americana likewise contains an article on the dumb and
deaf. The Christian Spectator for 1837, the New York Literary and
Theological Review for 1835, and the Biblical Repository for 1842,
also contain articles on the existing state of the art of instructing the
deaf and dumb. Tales and poems bearing upon the subject of muteism
have likewise appeared from the pens of Mr. Nack, Mr. Burnett, and
Mr. John Edwin Mann,—the latter a deaf mute, educated at the Hart-
ford Asylum.
In October, 1847, appeared the first number of the American Annals
of the Deaf and Dumb, originally conducted by the instructors of the
American Asylum, and afterwards ably edited by Mr. Luzerne Rae,—
a quarterly periodical which continues to the present time. This is by
far the most valuable publication connected with the subject on which
it treats at present in existence.”
The additions of the American editor, (who modestly declines
the usual editorial distinction of a place in the title-page,) are
valuable and judicious. He has appended to the author’s obser-
vations on Syringing, an account of a useful instrument invented
by Dr. Hullihen, of Wheeling, Va., to enable patients, without
aid, to syringe out the external meatus for themselves. On the
subject of counter irritation, he recommends and describes the
Cantharidal Collodion, as a desirable substitute for the ordinary
blistering ointment. Malformations of the ear are illustrated by
the editor, with an interesting case of Professor Mussey’s, of
“ congenital absence of the meatus auditorius externus of both
ears, without much impairing the hearing.” Other interesting
cases, extracted from American journals, are appropriately in-
troduced by Dr. Hewson ; and we notice also a very good ma-
nipulative suggestion, from the same source, for the application of
caustic solution to the mouth of the Eustachian tube.
The wood-cut illustrations of this work are exceedingly well
done; and its general appearance is of the highest style of
American publications. It is, emphatically, a good book.
A Treatise on Operative Ophthalmic Surgery. By H. Haynes
Walton, F. R. C. S., Surgeon to the Central London
Ophthalmic Hospital, &c., &c. First American from the
First London Edition. Illustrated by One Hundred and
Sixty-nine Engravings on Wood. Edited by Squire Littell,
M. D., Author of a Manual of the Diseases of the Eye,
Surgeon to Wills Hospital for the Eye and Limbs, &c. &c.—
Philadelphia, Lindsay & Blakiston, 1853. 8vo. pp. 599, (in-
cluding Index.)
The remarkably handsome style in which the American edition
of this attractive book has been produced, does great credit to
its enterprising publishers. Some acquaintance with the London
original had disposed us to look with interest for the present re-
print, and a closer examination of the latter has more than ful-
filled our previous expectations. The notes and corrections of
its distinguished editor, taken in connection with its near ap-
proach to the English copy in engraving and typography, have
rendered it, what reprints always ought to be, decidedly more
desirable than its foreign prototype. At all events, the manner
in which Dr. Littell has been seconded by the publishers in the
getting up of the volume, materially enhances the value of
his share of the undertaking, and must rapidly secure the fa-
vorable reception which he anticipates in his preface, and com
siders so abundantly justified by the intrinsic merits of the
treatise.
These merits are so clearly and faithfully set forth in a few
words of this preface, that we cannot do better for our readers,
or the book itself, than to insert them here.
“It is evidently the production of a thoughtful and independent ob-
server, thoroughly acquainted with his subject, and capable of imparting
to others, clearly and plainly, the knowledge which be possesses. The
information it contains is, for the most part, accurate and precise, and
its preceptive teachings practical and judicious. The reader is not per-
plexed by the necessity of determining for himself the relative value of
different modes of procedure; but is authoritatively instructed in that
which experience has proved to be the most appropriate for the accom-
plishment of his purpose. The sound principles of pathology which it
inculcates, derived from the best schools of English Ophthalmology, na-
turally lead to a rational and conservative treatment. It embodies the
results of extensive literary research and close personal observation, un-
der circumstances of rare opportunity; and though of unequal excellence
—some parts being more carefully written and more fully developed
than others, with occasional discussions also of topics not strictly in-
cluded in its title—is alike creditable to the author, and a valuable con-
tribution to ophthalmic surgery. It has been very favorably noticed
by the leading medical journals of Great Britain, and is the subject of
especial commendation by a distinguished authority. ‘In the whole
range of ophthalmological literature,’ says Dr. Mackenzie, in a review
which is not sparing of criticism, ‘we know of no work that, on the
whole, better deserves a place in the library of the surgeon. It is full of
sound and practical views, and shows the rapid advances which are
being made in this department of the medical art. Most of the cases
have occurred to the author himself, and prove him to be an observing
and able practitioner. His style is good, being perspicuous and unaf-
fected ; and any errors in the book are few and trivial in comparison of
the mass of accurate information which it contains.’”
Mr. Walton does not confine himself to a logically strict dis-
cussion of the mere operations on the eye and its appendages.
He naturally avails himself of the elastic meaning of his title,
and treats his readers to something more agreeable and useful
than a dull routine account of mere manipulations, which of
themselves comprise but a subordinate part of the whole range
of operative ophthalmic surgery. In fact, like most of the stan-
dard issues from the British press, our author’s treatise appears
to be much more practical and substantial, than it is formally
precise and systematic. While he does not affect to exhaust his
subject, either in details or outline, he has nevertheless supplied
the working practitioner with an amount of available instruction,
in regard to the surgical treatment of the eye, that will not
easily be displaced by the elaborate teachings of much more
voluminous guides. We are not inclined, therefore, to com-
plain because in treating of operations on the eye he has inci-
dentally favored his readers with a great deal of interesting
information on the pathology, diagnosis and therapeutic manage-
ment of several injuries and diseases of the visual organs. We
consider this liberal treatment of his subject one of the best
points of his book, and one that cannot fail to prove in it a great
source of popularity, as well as actual utility among the profes-
sion of this country.
The twenty-one chapters treat successively—1st. Of the use
of chloroform in Ophthalmic Surgery ; 2. Of Ophthalmic instru-
ments in general; 3. Of injuries ; 4. Of foreign bodies on or in
the eye, larvae under the lids, ossification of the occular tissues ;
5. Affection of the eye lids, and of the lachyrmal passages ; 6. Af-
fections of the lachrymal outlets ; 7. Caries of the orbit; 8. Naevi
and vascular tumors; 9. Scarification in chemosis ; 10. Stra-
bismus; 11. Tumors; 12. Protrusion of eye-ball; 13. Staphy-
loma; 14. Conical cornea; 15. Removal of opacities; 16. Ca-
taract; 17. Entozoa; 18. Artificial eyes; 19. Malignant affec-
tions; 20. Artificial pupil; 21. Extirpation.
The chapter on the use of chloroform, presents a new feature
in the study of Ophthalmic Surgery. The account of it in this
instance is clear, concise, and sufficiently full for practical pur-
poses, although we confess that we should have been glad to find
some kind of exposd of the positive or approximative therapeutic
results from operations under chloroform and other anaesthetic
agents. Anaesthesia is still regarded here as a complication not
to be desired in most operations on the eye ; and we want some-
thing more assuring than even Mr. Walton’s great experience,
to satisfy our doubts as to the ultimate advantages of such an
almost indiscriminate resort to chloroform, as he would seem to
advocate. “ Except the operation for the extraction of ca-
taract,” he says, “or the division of the cornea, to a like or
nearly equal extent, for any other purpose, there is no operation
on the eye in which well-founded objections exist to the previous
use of chloroform, or ether, as anaesthetic agents.” The objec-
tion arises, in the cases mentioned as exceptional, from the risk
of vomiting and consequent loss of the vitreous humor. This
danger of vomiting affords, in our view, a serious objection to the
use of anaesthetics in many other operations not included in the
above exceptions. At any rate, the question to be answered is
cui bono in many of the comparatively slight and easily tolerated
surgical procedures which have to be performed. We can
readily appreciate its value in operating upon children or timid
patients, or upon very sensitive or irritable adult eyes; but be-
yond this, we think, more definite rules of action are needed for
our guidance in the resort to it, than Mr. Walton has thought
proper to lay down.
Chapter 2d is occupied with the consideration of ophthalmic
instruments in general, upon which it presents us with some ex-
cellent remarks. Lightness, small size, and good order as to
points and edges, are dwelt upon as indispensable requisites in
all these implements. Cataract needles, knives, and the like,
should have wooden handles, small, round and smooth, in pre-
ference to the old fashioned and many sided ivory holders gene-
rally employed. The wood-cuts in this chapter are, like the
illustrations throughout the book, appropriate and admirably
done. Here and elsewhere, they facilitate most effectually the
precepts and descriptions of the text, and constitute one of the
strongest attractions of the volume.
The third chapter is one that might not be looked for in a
dissertation on operations, since it is devoted to injuries from
mechanical or chemical agents. It contains a good deal of in-
structive matter, and many useful hints; so that whether out of
place or not, it must prove acceptable to the great majority of
readers, and could not conveniently be spared. Chapter fourth,
like its immediate predecessor, is not wholly occupied with ope-
rative surgery, and is none the less valuable and interesting,
being principally engaged with the subject of foreign bodies in
the cornea and within the ball. The number of cases detailed
in these two chapters, renders them in the highest degree useful
to practitioners of every grade, all of whom are liable to the
emergencies which are here forcibly described and illustrated.
The next chapter, which is a capital one in all respects, treats
at length of various affections of the eye-lids, such as abscess,
symblepharon, anchyloblepharon, epicanthus, ptosis, trichiasis, en-
tropium, entropium with trichiasis, ectropium, obstruction of the
meibomian ducts and conjunctival calculi. This is followed by an
interesting chapter on affections of the puncta, canaliculi, and what
he calls the lachrymal tube ; by a chapter on caries of the orbit;
by another, very carefully prepared, on naevi materni and venous
and arterial aneurismal growths; by one on incision of the che-
mosed conjunctiva in purulent ophthalmia, and by another on
strabismus. Then we have a well furnished chapter on tumors
of the eye ; another, also good, on protrusion with anaemia and
enlarged thyroid, and on exophthalmia from other causes, on rheu-
matic inflammation of the occular sheath, periostitis, abscess and
inflammation within the orbit, and disease of the optic nerve.
Next follow three shorter chapters, devoted respectively to sta-
phyloma and its attendant characteristics and remedial manage-
ment, to conical cornea, and to the treatment by operation or
otherwise, of opacities of the cornea. In discussing the various
topics above hastily enumerated, Mr. Walton, without pre-
senting much that was actually new, has managed to enrich
his pages with many highly interesting cases, and a great deal
of pertinent matter, which, accompanied and qualified as it
occasionally is by the comments of his American editor, will
afford the practical inquirer more material aid than could be
gleaned in the same time, from any other work yet extant on
the subject.
Our limits forbid the notice of many points, which in a more
elaborate review would suggest themselves to our attention. We
might dwell with advantage upon several questions of theory and
practice, as well as upon some important observations—such, for
example, as those concerning trichiasis and entropium, their
causes and best mode of cure, the phenomena of exophthalmia,
the effects of certain conditions of the lens in staphyloma, the
treatment of naevi and vascular tumors, the history and manage-
ment of other morbid growths, the ablation of opacities, &c., &c_
but we are obliged to hasten to a close, with an equally brief
glance at the remaining six divisions of our author’s task.
The first of these, (chap, xvi,) is a long and able one on ca-
taract. The whole subject is here considered in extenso, and
with a praiseworthy attention to matters of practical detail in
the previous and subsequent care of the patients, as well as in
the different stages and modes of operating. We arc glad to
find the needle recommended by Mr. Walton, and represented
in the marginal engraving, to be substantially the same as that
preferred by the operators at the Wills Hospital in this city, and
which has been employed with so much success (about 80 per
cent cured according to Dr. Littell) upon the patients of that
house.
Chapters xvii and xviii are occupied with entozoa and cysts
within the eye and its appendages, and with artificial eyes. Chap-
ters xix and xx, the one on malignant diseases of the eye, and
the other on artificial pupils, are two long and admirable papers,
which are decidedly the best of the book. Chapter xix espe-
cially, in its whole character, arrangement, matter and sound
conservatism of doctrine and precept, commends itself to the at-
tention and respect of every reader, and can not fail to secure
an honorable position to the whole work, independently of all
other claims, Chapter xx, on artificial pupil, is scarcely less
worthy of approval for clearness and beauty of arrangement and
illustration, and for the interest and variety of the cases cited
in connection with the different questions belonging to this im-
portant subject. The conditions under which an operation may
be undertaken, and those which contra-indicate it, the relative
advantages of the several positions in the iris for a pupil, the
size and shape of the pupil, the classification of the principal
morbid states of the eye requiring a pupil, wuth the most appro- *
priate operations—are all handled in the very best manner.
The only remaining chapter treats of extirpation of the eye-
ball, and of the entire contents of the orbit. We take our leave
of our author and his editor, with a quotation which neither will
regret to see again in print, and which we place before the
readers of this journal, rather for the sake of the solemn lesson
it conveys, than as a specimen of Mr. Walton’s style :—
“ All that we have hitherto ascertained as to the origin and nature of
cancer, leads us to the conclusion that it is a constitutional, not a local
disease, and that the tumor or sore is merely the evidence of the poison
that is at work within; the outlet, so to speak, at which the materies
morbi endeavors to escape from the system. If this be true, it is evident
that any attempt to arrest the disease by the removal of its local mani-
festation can be attended only with disappointment; and that the illus-
tration adduced by Mr. Simon that we might as well attempt the cure
of gout by the amputation of the offending toe, is, in many respects,
strictly applicable. I do not mean to assert that cancer, when left to
run its course, is inevitably fatal; or that an operation for its removal is
invariably followed by its recurrence; cases occur, from time to time, in
which it disappears spontaneously from the system, by processes which
it is not necessary here to describe; and several well-authenticated in-
stances are on record, in which the extirpation of malignant growths,
even under the most discouraging circumstances, have been followed by
complete and permanent recovery. Such exceptional cases, however, are
so rare, and the conditions under which they occur are so little under-
stood, that it would not be safe to make them the basis of any practical
conclusion.” (p. 536.)
It is gratifying to meet with views of this high stamp, in re-
gard to questionable operations, in a work which is destined,
under its peculiar auspices, to exert a considerable influence on
the ophthalmic practice of the country. We take the greater
pleasure, therefore, in recommending it as a safe and convenient
adviser which ought to have its place in every medical library,—•
not as a substitute for Hays’ Lawrence, and Littell’s manual,
but as an admirable and most efficient companion to those indis-
pensable monitors.
The Practice of Surgery. By James Miller, F. R. S. E., F.
R. C. S. E., Surgeon in Ordinary to the Queen for Scotland;
Surgeon in Ordinary to his Royal Highness, Prince Albert, for
Scotland; Professor of Surgery in the University of Edin-
burgh; Consulting Surgeon to the Royal Infirmary ; &c., &c.,
&c. Third American, from the Second Edinburgh Edition.
Edited, with additions, by F. W. Sargent, M. D., one of the
Surgeons to Wills Hospital. Illustrated by Three Hundred
and Nineteen Engravings on Wood. Philadelphia, Blanchard
& Lea, 1853. pp. 720.
Notwithstanding the numerous treatises of a practical cha-
racter which have lately been issued from the press, this edition
of the Practice of Surgery of Prof. Miller, cannot fail to receive
an extended circulation. It is the third American from the
second Edinburgh edition, a fact which must be highly gratify-
ing, not only to the publishers in this country, but to the author
also, as an evidence of the appreciation of his labors on this side
of the Atlantic.
Many subjects are treated of in this edition, which were not
included in the last, and its numerous illustrations will, we have
no doubt, render it a far more acceptable volume. Indeed, the
student of surgery will find in the “ Principles ” and “ Practice ”
of Surgery of Professor Miller, (to use the author’s modest
phraseology,) “a tolerably complete system of surgery.”
The American editor, Dr. Sargent, has appended many valua-
ble notes and introduced numerous additional illustrations, which
greatly enhance both the appearance and usefulness of the
work.
We are glad to see, that the Bibliography, which was omitted
in the former editions, is now restored ; and we feel also called
upon to speak in high terms of the mechanical execution of the
book. It must maintain a prominent position as a standard
text-book in our medical schools.
The Maternal Management of Children in Health and Disease.
By Thomas Bull, M. D., member of the Royal College of
Physicians, author of “ Hints to Mothers ” for the Manage-
ment of their health during Pregnancy and the lying-in room.
Second Edition. Philadelphia, Lindsay & Blakiston, 1853.
A strong dislike to works on popular medicine may be said
to have existed in the profession from the early period of Bu-
chan’s “New Family Physician,” to the present time. A
meddlesome and opinionated state of mind, which shows itself in
words and deeds, is frequently created in those who use such
works, and this is not only annoying and disheartening to the
practitioner, but has often led to dangerous and even fatal con-
sequences.
Such are the arguments of those who object to popular trea-
tises on medicine. On the other hand, humanity, the eradica-
tion of old prejudices and superstitions, the inability of obtain-
ing medical advice, and the protection of the ignorant public
against the impositions of quackery, are brought forward by the
writers as pleas in satisfaction or in extenuation of their offence.
We shall sum up judicially by saying, after worthy old Sir Ro-
ger, “ that a great deal may be said on both sides of the ques-
tion.”
Dr. Bull makes three divisions of his subject:—“ The manage-
ment of children in health, the management of children in dis-
ease, and the prevention of scrofula and consumption.” For
many reasons, we prefer the first and last sections.
The style is plain and unpretending, and the advice sound and
sufficiently in detail. Where such books are needed, it may b©
safely recommended.
Dr. Hooper s Physician s Vade Mecum: or a Manual of the
Principles and Practice of Physic. Considerably Enlarged
and Improved. By William Augustus Guy, M. D., &c.
With Additions. By James Stewart, A. M., M. D., &c.
Philadelphia. E. Barrington & G. D. Haswell, 1853. pp.
541. (With Index.
This is one of the oldest and most popular of the “ Manuals.”
It was thoroughly remodelled some years since, under the able
editorship of Dr. Guy, and may now be safely commended to the
student as a very complete, clear, and accurate r^sumd of the
“ Principles and Practice of Physic.”
A Manual of Obstetrics. By Thomas F. Cock, M. D., Physi-
cian to the New York Lying-in Asylum, to Bellevue Hospital,
etc. New York. Samuel S. & William Wood, 1853. pp. 250.
(With Index.)
A hasty glance at this handbook has impressed us very favor-
ably of its merit. The author “makes no pretensions to origin-
ality,” in its behalf, but puts it forth as a compilation, the basis
of which has been his notes of the lectures of Professor Gilman,
of New York.
Hallucinations: or the Rational History of Apparitions and
Visions, Dreams, Ecstacy, Magnetism and Somnambulism.
By A. Brierre de Boismont, Docteur en M^decine de la
Faculte de Paris, Directeur d’un Etablissment d’Alifin^s, etc.
etc. First American, from the Second Enlarged and Improved
Paris Edition. Philadelphia, Lindsay and Blakiston, 1853.
pp. 553.
This book contains an immense mass of curious and interesting
o
cases on the subjects indicated by the title, which must give it
great value as a work of reference to the student of these topics.
The curious in such matters will find in it a most careful rdsum6
of all the “ authentic (?) facts ” connected with the subject in
question, classified and subdivided on scientific principles, and
studied in relation to their “ symptoms, causes, lesions, prognosis,
diagnosis and treatment.”
In the discussion of these topics, the author puts forth much
acute and occasionally deep speculation ; but there is a vein of
combined credulity and mysticism throughout the book, incompati-
ble with claims to a place among philosophical dissertations on
the subject of mental pathology. M. De Boismont distinctly
avows his “ sympathy with the grand creed of supernaturalism,”
and is, moreover, a believer in clairvoyance. He considers the
fact established, “ that persons and objects, in connection with
the person magnetized, can be seen by him under their real
forms and believes “ the phenomena of clairvoyance, prevision,
and second sight to depend on a sudden illumination of the
cerebral organ, which calls into activity sensations that have
hitherto lain dormant.”
The translation (from an anonymous pen,) is spirited and
agreeable. Occasional inaccuracies, (such as we will, constantly,
for we shall', the Port for Oporto, p. 65; &c.,) are noticeable;
and we feel bound also to hold the translator responsible for al-
lowing such blunders in English history to stand uncorrected, as
“ the Marquis of Londonderry, afterwarcis Lord Castlereagh,”
and “the Harrowby ministry.”
The Prescriber s Pharmacopoeia: Containing all the medicines
in the London Pharmacopoeia. Altered to correspond with
the U. S. Dispensatory. Third American from the Fourth
London Edition. By Thomas F. Cock, M. D. New York,
S. S. & W. Wood. pp. 178, (with Index.)
This will be found a most useful little pocket companion to
both the student and practitioner, containing in a very small
space a great amount of varied information, on subjects of every-
day importance.
On the Use of Chloroform in Midwifery. By George N.
Burwell, M. D., one of the Physicians of the Buffalo Hos-
pital.
Fracture Tables. By Frank IT. Hamilton, M. D., Professor
of Surgery in the University of Buffalo.
For these highly valuable statistical pamphlets, we are in-
debted to two distinguished physicians of the accomplished pro-
fession of Buffalo; a city which is rapidly becoming elevated by
the energy and talent of her leading physicians, to the position
of a medical centre.
Dr. Burwell gives the statistics of one hundred and eighty
cases, in which he administered chloroform for the relief of labor-
pains. He does not discuss the propriety of administering this
agent; but, waiving argument on that point, he gives us, first,
his statistical results upon the most important points of the cases
in which he administered it; secondly, an account of its effects,
as noticed by him, upon the symptoms and progress of labor;
and, thirdly, his mode of exhibiting it, the doses in which it may
be safely given, and the rules by which he is governed in its use.
Dr. Hamilton’s Fracture Tables are an important addition to
the statistics on this subject.
Transactions of the Tennessee State Medical Society, at their
Twenty-fourth Annual Session, convened at Nashville, May
4, 1853.
This volume contains, with the proceedings of the Tennessee
'State Medical Society, an interesting address on the history of
Medicine, by Dr. J. M. Watson', President; a valuable report
on the adulteration of medicines, by Dr. R. 0. CuRREY ; reports
of Committees, by Drs. W. P. Jones and G. B. Haskins ; and
cases by Drs. Ramson, Park, Knight, and Bowlin. The Trans-
actions are most creditable to the Profession of Tennessee.
The Physician s Visiting List, Diary, and Book of Engage-
ments, for 1854. Philadelphia, Lindsay & Blakiston.
This most convenient little work has already been issued, for
1854, by the enterprising publishers. Several improvements
have been made in it, and it has been simplified by the with-
drawal of all extraneous matter, except a table of poisons and
antidotes. No physician, who has ever had the advantage of so
useful a pocket companion, can, we are satisfied, afford to be
without it.
The Microscopist; or A Complete Manual on the Use of the
Microscope. With Illustrations. By Joseph H. Wytiies, M. D.
Philadelphia, Lindsay & Blakiston, 1853. pp. 212 (with Index.)
The value of this useful little manual has been well shown in
the rapid exhaustion of the first edition in little more than a
year. Numerous important additions have been made to the
present edition, which is highly creditable to both the author and
publishers.