BIBLIOGRAPHICAL NOTICES.
A System of Practical Surgery. By William Fergusson,
F.R.S., Professor of Surgery in King’s College, London; Sur-
geon to King’s College Hospital; and Surgeon to H. R. H.
Prince Albert. Fourth American, from the third and enlarged
London edition. With three hundred and ninety-three illus-
trations. Philadelphia: Blanchard & Lea, 1853. 8vo. pp.
621, including index.
The fact that since its first appearance, ten years ago, the
Practical Surgery of Prof. Fergusson has reached a third London
and fourth American edition, affords abundant evidence of the
great esteem in which it has been held on both sides of the
Atlantic. The reputation of its author, as well as of the
work itself, have been too long and too favorably familiar to our
readers to require any detailed notice of the many new and
strong claims upon their attention accumulated in the edition
just presented to us. The marks of progress may be noted not
only in the additional illustrations, of which there are over a
hundred, but in the better arrangement as well as enlargement
of several chapters, the discussion of recent improvements, and
the consideration of many topics which were not alluded to or
very slightly touched upon in previous editions. The nature
and variety of these additions, however, must render it of
course impracticable to dwell upon them here; and the best
we can do for the book itself, as well as for our readers, is to
recommend all who desire one of the most instructive manuals
of practical surgery, to provide themselves at once with copies
for their private reading. Meanwhile it may not be amiss to
extract two passages from different portions of the book, which
are interesting in themselves, and will serve to show the deter-
mination of the author to keep pace fully with the progress of
the times. The first relates to the use of anaesthetics, and espe-
cially of chloroform, in operations. On this topic he remarks in
conclusion:
“ While the custom of rendering patients insensible to pain, during
the performance of surgical operations, has rapidly gained an undoubted
and sure position, there have been various questions and drawbacks
regarding it, many of which are, even at the present day, of great
practical importance. Several deaths have occurred, to all appearance
directly from the anaesthetic agents, or the mode of their administra-
tion, and there has been much discussion on both these points. In the
early application of ether, a complicated apparatus was used, but soon it
was found that by holding over the patient’s nostrils and mouth, a hand-
kerchief, napkin or piece of sponge, moistened with a few drops of the
anaesthetic, the desired effect was speedily produced, and to this day,
perhaps the majority of those who use the agent are content with this
mode of administering it. From the commencement it has been the
custom of most surgeons in large operating practice, to have the agent
administered by some one whose sole attention might be given to its
physiological effects on the patient during the performance of the opera-
tion j and among those who have performed this most important duty,
there are few so extensively experienced as Dr. Snow. This gentleman,
who is justly deemed our highest authority on the subject of anaesthesia
in surgical operations, is in the habit of using an apparatus, as he is of
opinion that there is less danger and more certainty thereby than with
a napkin. There are different views on this subject, however, which
need not be discussed here, and it may be sufficient to say that in what-
ever way the agent is called into use, its powers are fraught with subtle
and imminent danger, unless the greatest caution be taken. For my own
part I think it of little consequence by what means the agent is admi-
nistered, provided there be a fair proportion of atmospheric air admitted
to the lungs at the same time, or that there be the facility of admitting
it, when the influence of the chloroform, or whatever agent is employed,
seems too powerful.
“At one time it was supposed that certain states of the constitution,
certain conditions of the disease, or affections of certain organs, must
preclude anaesthesia in surgical operations, but experience has shown
that these fears have all been groundless. The age of a patient forms
no objection to its use, for it may be given during the first few weeks of
life, or at the latest imaginable elate. Nor does it appear that positive
disease of any organ forms an insuperable objection to its use. There
are certain circumstances in the state of the constitution which will
deter the surgeon from performing any important surgical operation,
and in such instances the propriety of anaesthesia need never be dis-
cussed ; but as a general answer to all questions on this score, I am dis-
posed to say, that in whatever case a surgeon may consider an operation
justifiable, the use of chloroform (this is named as the agent in most
common use) is equally justifiable. If the operation be of minor im-
portance, and of momentary duration, especially if the patient be cou-
rageous, and perhaps adverse to the practice, the surgeon need say little
on the subject; but in all cases where much and protracted suffering is
likely, chloroform should be recommended. It will not only save pain,
but avert shock, and, provided the agent be properly administered, it
will render the surgeon’s duties more easy of accomplishment. There
are few operations in which its use is not admissible and advantageous.
In operations for cataract, especially by extraction, it is likely to prove
injurious ; as there is no certainty as to the movements of the eyeball
and lids for some time after. I have used chloroform for removal cf
tonsils, in young persons, but the operation is difficult, and if the patient
will keep steady otherwise, it had better not be used. In staphyloraphy
the co-operation of the patient is so essential, that I deem chloroform inad-
missible. It has been supposed that there is danger from blood trickling
into the larynx and trachea in operations under chloroform. In one in-
stance, in the early days of chloroform, I took some alarm on this score, in
a case where blood was trickling from the posterior nares into the trachea
and causing cough, but I feel now certain that there was no just cause of
apprehension. I have since repeatedly removed both upper and lower
jaw, and done many other operations involving considerable hemorrhage
towards the throat, but have never seen any more inconvenience from
such a cause than if chloroform bad not been used. It has happened
repeatedly in former times, that persons have died during^the perform-
ance of operations. Mental emotions, shock, hemorrhage, have each
and all had their influence ; but, notwithstanding the various instances
in which death has happened under chloroform, it may be doubted if
sudden death, during operation, has occurred so frequently since the
introduction of anaesthesia, as prior to that date. In my own experi-
ence I have twice seen patients under chloroform in great jeopardy—one
of these had a protracted operation performed for resection of a joint,
and possibly a similar state of prostration might have resulted without
the use of this agent. In the other instance, tracheotomy was required
for disease of the larynx, and under the chloroform, respiration became
so slow and difficult, that it was feared the patient would die on the
instant, before the operation could be executed. When the trachea was
opened, he immediately breathed more freely, and speedily rallied from
his alarming condition.
111 was certainly more impressed with the danger in this instance
than in any other that I had seen ; but Dr. Snow, who administered
the chloroform, did not participate in my fears. The immediate effect
of tracheotomy corroborates the view entertained by Ricord and others,
that this proceeding may be resorted to with advantage when there
seems danger from chloroform. When death has occurred seemingly
from this agent, it has been immediate, and chloroform leaves the system
so speedily, that if the patient has once become conscious, I doubt if
death could ever be attributed to this cause. Chloroform has no influ-
ence whatever, either in retarding or accelerating the healing of a wound.
We have no statistical data on this subject, but altogether the impres-
sion on my mind is, that a patient is better off with chloroform both
under and after an operation, than if he were without it. When an
operation is contemplated under chloroform, almost the only precaution
worthy of being taken is, that food should be avoided for several hours
before, as chloroform on a full stomach is almost certain to induce sick-
ness. So much has been written on the subject of chloroform since its
introduction, that I deem it unnecessary to say much more regarding it at
present, and I trust from what has been stated, that it will be understood
that, with the few exceptions above made, and such others as might
incidentally arise, the use of this agent is recommended as an invariable
accompaniment of all surgical operations involving pain.
“ The quantity of chloroform required for different patients is very
variable. A few drops may suffice for some, while drachms may be
needful for others, and generally the amount will be in proportion to
the duration of the operation. Some persons take it kindly, even
greedily, others make great objection and resistance to its use, both
while conscious and unconscious, but all can be at last so thoroughly
overpowered by its influence, that, compatible with respiration and cir-
culation, the greatest imaginable quietness can be obtained. There is
very little effect on the pulse in such cases; sometimes it is slightly
excited at first, and if the dose be very potent, it may become slow and
weak. There is greater effect on respiration. In some, in the early
stages, the movements are rapid, and there seems an eagerness to fill the
lungs with tlft vapor. In others, a tickling cough is excited. In many
the full effect is induced with as slight a perceptible change as if sleep had
suddenly come on, but in many others great irregularity in the respira-
tory movements ensues, and much cerebral excitement is induced.
Bapid breathing may happen, as already mentioned, but the reverse
may be the case, and the power of inspiration may suddenly seem to
have ceased. For many seconds there may be no seeming attempt at
respiration, but at last a deep breath is usually taken, which makes
amends for the previous cessation. The cerebral excitement is evinced
by crying, bawling, singing, laughing, incoherent talking, and with
many there seems some prevailing idea which calls forth unusual and
often great muscular action. Some strike forcibly with their fists, and
with no seeming want of skill; others use their lower extremities, and
others again make such violent general struggles as necessitate the
greatest muscular exertion in those around to keep them steady. Often
these violent struggles and the temporary cessation of respiration fall
together, and to those not accustomed to such scenes, it appears as if
immediate dissolution were impending; but in all such cases a little
more of the vapor induces all that quietude which is characteristic of
its full effect for the surgeon’s purposes. There are various ways in
which it may be decided that this period has arrived. Muscular relaxa-
tion is one of the best, but perhaps there is no test equal to that of
touching the surface of the eyeball with the point of the finger. If
there be any indication of feeling, the proper time has not arrived; if
the contrary, then the surgeon may proceed. The agent must be ad mi-
nistered during the operation as may seem necessary, and it is best to
continue its influence until all risk of pain, at the time of operation or
dressing, has passed. In most instances it is highly desirable that the
patient should be placed in bed before awaking from his anaesthetic
trance. In many cases much mental and bodily suffering may be
avoided by administering the chloroform before the patient is moved
from bed. In painful diseases of joints, such as of the knee, there is
often great suffering in carrying the patient to the operating table,
which may, however, be avoided by using chloroform before he is dis-
turbed. Some patients become conscious in a few minutes after the
surgeon has ceased his work, while others remain for a longer period as
if in calm sleep. In certain instances headache and general uneasiness
are complained of for hours or even days after chloroform ; but in the
majority of cases the effects are slightly if at all felt when conscious-
ness returns.” (pp. 33—35.)
The second extract contains his appreciation of the treatment
of aneurism by compression.
“ So far as our comparatively limited experience in the method by
pressure, as followed by the Dublin surgeons, will enable us to form
an estimate of its value, it seems in many respects, if not in all, pre-
ferable to that by deligation of the main artery; and there seems these
great advantages in it, that if it does not act satisfactorily, the Hun-
terian operation may still be resorted to, with as much probability of
success as ever, while by its application none of those formidable dan-
gers are incurred, which are the well known consequences of the appli-
cation of the ligature. The difficulties and immediate dangers of a
cutting operation are avoided. It may seem strange to make use of
such language in the present day, as applicable to ligature of the super-
ficial femoral artery—’for that I assume to be the vessel meant by the
unfortunately vague term of ‘ femoral nevertheless when it is known
that great difficulties have been experienced in such a proceeding, even
by hospital surgeons and teachers of surgery, and that the accompany-
ing great vein has been wounded by different operators, the facts cannot
be overlooked. Mr. Syme states in the Edinburgh Monthly Journal of
Medical Science for November, 1851, that he has tied the superficial
femoral artery twenty times without a fatal issue, and with perfect suc-
cess, and both he and his patients may be congratulated on such satis-
factory results ; but the Tables above referred to show no such average
success; and when it is borne in mind that the attempt at cure by
pressure does not preclude the resource of the ligature, it seems to me
that with the ample evidence before us of the great success which has
attended the modern practice by this means, the surgeon should un-
doubtedly give it atrial ere he resorts to the knife. Unquestionably
the evil result of the Hunterian operation, in regard to ligature of the
superficial femoral artery, has in many instances resulted from the
defective or injurious style of operation, but the same may be said of
certain examples where pressure has failed. Granting both of these
statements to be correct, it cannot be overlooked that ligature of the
superficial femoral artery, done to the perfection of human skill, has
nevertheless been followed with the worst possible results. I have seen
Mr. Syme perforin the operation repeatedly with admirable skill and
precision in all points, and the results have been all that could be
desired ; but I have seen many others, and among them I may name the
late Mr. Liston, perform the same operation, with an equal amount of
tact and judgment, yet the results have been very different. V\ ith
pressure, surgery has still further resources, but wiih the ligature the
fate of the case is, for a time, placed almost, if not quite, beyond human
power; and doubtless the surgeons of Dublin who have resorted to this
practice (many of whom stand among the highest of those who have
graced the annals of the profession) have duly considered all these
points.” (p. 128.)
Atlas of Pathological Histology. By Dr. Gotleib Gluge, Pro-
fessor of Physiology and Pathological Anatomy in the Uni-
versity of Bruxelles, &c. Translated from the German by
Joseph Leidy, M. D., Pathologist to St. Joseph’s Hospital, &c.
With three hundred and twenty figures, plain and colored,
and twelve copper-plate engravings. Philadelphia, Blanchard
& Lea, 1853.
The student of pathological anatomy will not fail to recognize
the name of Gluge, as one of the most industrious contributors
to this department of medical science, and those familiar with
liis great work ’will also see, as an old friend, the present work
originally appended to it.
Extending over only one hundred pages, it fulfils its title
of. Atlas in all particulars. The introduction occupying six-
teen pages, gives us valuable tables of the magnitude and
weight of the organs of man, in the normal and abnormal
conditions.
A few introductory remarks on pathological histology open
the division of the work devoted to this subject. It is divided
into seven sections, each of which is clearly but succinctly ex-
pressed.
Section 1st treats of the development of the elements of
tissues, and includes : 1, elements of tissues ; 2, development of
cells in the extended plasma of capillary vessels, in which the
different modes of cell formation are treated of, and the paral-
lelism between the pathological and physiological developments
shown, together with the development of fibres.
Section II is entitled, “ The elements of the tissues combined
in perfect or imperfect tissues, and arranged according to the
process of disease.” It treats of the tissues and elements of
the tissues in an imperfect condition of development; cytoblas-
tema nucleoli, nuclei and cells. Of transition forms to perfect
tissues. Of perfect tissues.
Section III treats of the formation of the blastema, the
sources from whence the plastic substance is derived which
forms the material for the development of the new tissues : these
are, according to the author, nutrition, secretion and inflam-
mation.
The different stages of inflammation are spoken of under the
heads of congestion, hypersemia, stasis, exudation and gangrene ;
each of which has a short section to itself; the formation,
diagnosis, and chemical relation of pus, receiving a full share of
notice.
Section IV is upon the histological metamorphosis of the
blood, interior and exterior to the vessels.
Section V is devoted to the subject of pyaemia, and is illus-
trated by numerous observations.
Section VI is on gangrene, which it treats briefly.
Section VII contains observations on histology, illustrative of
the various subjects treated in the preceding pages.
Next follows twelve well executed steel plates, containing
three hundred and twenty figures in the best style of the art,
with the explanation of each. Although there are many points
where the author differs from standard authorities, yet, upon
the whole, we are pleased with the book, and recommend it to
all our readers who may be interested in this department. That
it is entirely reliable, we cannot say, and by itself can do very
little good or harm. No one will be satisfied with it alone, and
a very slender acquaintance with other authorities will correct
the errors of this. The translator has had many difficulties to
encounter in rendering it into English, but he has performed
his task creditably, and his few additions enhance the value of
the work.
Handbooks of Natural Philosophy and Astronomy. By Dionysius
Lardner, D. C. L., &c., &c. Second Course. Heat, Magnet-
ism, Common Electricity and Voltaic Electricity. Illustrated
by upwards of two hundred engravings on wood. pp. 451.
Philadelphia, Blanchard & Lea, 1853.
The name of Dr. Lardner has long been known to the scientific
world as one of the best of English writers on the various de-
partments of the Physical Sciences. His treatises on the Steam
Engine, and on other branches of physics, have for years been
familiar in our schools and colleges as standard authorities.
The handbooks of Natural Philosophy and Astronomy, which
are now in course of re-publication in this country, are designed
by their author more especially for students of the different pro-
fessions, for the artisan, and, in fine, for those who are already
engaged in the active callings of life, but who desire to sustain
and improve their knowledge of the general truths of physical
science. They will be found admirably adapted to promote this
end, by imparting, in a very clear style, a due amount of infor-
mation without pursuing them through their mathematical de-
tails.
The study of the physical sciences form a part of every ex-
tended system of modern education. To the medical man, how-
ever, it is presented with peculiar claims to attention, since so
many of the functions of the living body, and so many of the
appliances which his art has suggested as remedial agents in
disease, belong strictly to the domain of physics.
The present treatise is a most complete digest of all that has
been developed in relation to the great forces of nature—Ileat,
Magnetism and Electricity. Their laws are elucidated in a
manner both pleasing and familiar, and at the same time perfectly
intelligible to the student. The illustrations are sufficiently
numerous and appropriate; and altogether we can cordially re-
commend the work as well deserving the notice both of the prac-
tising physician and the student of medicine.