onion. Does he suppose that the concentric laminæ, which that bulb exhibits, prove "that they were formed at different periods, separated by longer or shorter intervals ?"

Whatever may have been the previous nature of the calculus, the phosphatic diathesis always prevails whenever the patient's general health gives way. The coats of the bladder then become thickened and diseased, and often, he might have added, disorganization of the kidney itself takes place, and death closes the scene.

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The local treatment of calculi is nearly the same in all the species, consisting principally in the employment of anodynes. Hyoscyamus is in general to be preferred in the lithic acid diathesis, and opium in the phosphatic." (Page 202.) This is urged in consequence of the author's having noticed, that "opium frequently increases the formation of the lithic acid," (page 177,) an observation which we think of great importance, considering his extensive recommendation of this remedy in the diseases of the urinary system.

The general treatment depends, of course, upon the nature of the diathesis which is present; and it may be understood from what has been already stated. It is important to bear in mind, that while the urine is in its natural state, the calculus cannot increase in size. When, therefore, the diathesis, more particularly the lithic diathesis, has been broken in upon by medicine, the effect is to be kept up by strict attention to diet and regimen, and the patient may live on, scarcely knowing that he has a calculus in the bladder.

In the cure of a calculus composed of the phosphates-

"It should be our object, as in all other affections of this description, to restore the urine as speedily as possible to its natural state. I am sorry, however, to be obliged to confess that I have never been able to accomplish this purpose in a single instance, even after the most fair and persevering trial of almost every remedy that has hitherto been recommended, or that I could devise as likely to effect my purpose. The consequence has been, that I have never been able to procure more than a temporary relief from suffering by the various exhibition of opiates, &c. The operation of lithotomy, therefore, seems to be the only alternative in this form of the disease. If, however, the case is doubtful, or the patient refuses it, or his situation will not admit of the performance of the operation, recourse may be had to the means formerly pointed out when the nature of this diathesis was treated of in detail." 206.

The last chapter contains a number of valuable observations on the influence which periods of life, sex, and climate, exert over calculous complaints; on the mortality attending lithotomy, and the circumstances of a general nature, which

should incline us to recommend, or to dissuade from, that operation. We have occupied so much space with the author's general views, that we have really no room to spare for the details into which we should be led by a full analysis of this chapter. There are two or three remarks, however, which we noted down as particularly interesting, for which we must endeavour to find a place.

Dr. Prout seems to think (page 211) that a large proportion, perhaps the majority, of lithic acid calculi are formed in very early life; and that no urgent symptoms are occasioned by them till towards the age of forty.

"The heyday of life has now past; the individual has perhaps been married for some years, and, from being less active, has become corpulent and gouty; for some time past the irritation in the bladder has been more frequent and urgent, and he observes that his urine is loaded with gravel; he now begins to take the alarm, and to be apprehensive that his complaint may terminate in stone; a surgeon is consulted, who confirms his apprehensions; and here begins the tale of wo; his new disease haunts him perpetually, and soon begins to affect his health and spirits; at length his constitution gives way-an irritable state of the system comes onthe phosphatic diathesis is induced, and a cruel operation, or a miserable death, is the only alternative." 213.

The phosphatic diathesis occurs sometimes as an original disease in the prime of life, without being preceded by the lithic acid, or any other diathesis. (P. 215.) Calculus is less frequent at present than it was formerly. (Page 216.)

The operation of lithotomy is to be recommended without delay, whenever a calculus, no matter of what species, is ascertained to exist in the bladder before puberty-where the phosphatic diathesis is fairly formed-and, lastly, when the urine is loaded with pale-coloured lithate of ammonia; for in this case the phosphatic diathesis cannot be prevented, nor the lithic diathesis restored. On the other hand, the operation may be postponed, when the calculus is small and the lithic diathesis steadily present-when the patient is in the prime of life and the health sound, and where he is willing to conform to regular living. Under all other circumstances the retention of the calculus in the bladder is dangerous.

Before parting with Dr. Prout, we must offer him our thanks for the instruction which he has afforded us ; and, for his sake, express our hopes, that we may have been successful in conveying to our readers a clear and impartial idea of the views which he has formed of the deranged operations of the urinary organs.

VIII.

A Synopsis of the Diseases of the Eye, and their Treatment; to which are prefixed, a short Anatomical Description, and a Sketch of the Physiology of that Organ. By BENJAMIN TRAVERS, F.R.S. Surgeon to St. Thomas's Hospital. One vol. 8vo. pp. 425, six plates, 32 beautifully coloured engravings. London, 1820.

"Vel me monere hoc, vel percontari puta :

"Rectum est, ego ut faciam; non ut deterream." Ter.

We believe we shall be credited when we declare that our analytical labours are generally performed "con amore," and without any of those feelings of languor, dejection, and disrelish which must often oppress the author whose hard fate it is "to force a churlish soil for scanty bread." Yet we are compelled to confess, however reluctantly, that the perusal of some works puts our patience and our temper completely to the test, whether by generating a great flow of bile, and corresponding irritability of mind;-or by enveloping us in a kind of Beotian atmosphere that stupifies us for a time, until we are enabled to emerge into the cheerful sunshine of intellect once more. On the other hand, when we meet with a work of sterling merit, and at the same time, well arranged and well written, we enjoy at least the "feast of reason," if not the "flow of soul;" and it need hardly excite surprise if, in such cases, we prolong the genial banquet to a late hour, from a consciousness that such treats must be comparatively few in our literary journey through life.

We feel ourselves under deep obligations to the ingenious and able author of the work before us, and the profession will undoubtedly appreciate the valuable mass of facts and ⚫ observations which Mr. Travers has here presented them from extensive personal experience-being, indeed, "the result of a more ample opportunity of observing the diseases of the important organ of which it treats, than commonly falls to the lot of hospital surgeons." This opportunity is derived from a period of seven years official situation as surgeon to the London Infirmary for Diseases of the Eye, besides a wide range of private practice. Our author is of opinion, that "the advantages obtained by the subdivision of professional talent and labour, are infinitely overbalanced by those which arise from the general and undivided application of these instruments of knowledge ;" and he thinks Vol. II. No. 5. P

this doctrine is strikingly illustrated by the prejudice arising to ophthalmic science in this country, from the confinement (formerly) of that branch in the hands of a few. This is now at an end, and the respectable exclusive oculist will be a name unknown in the next generation. The institutions for treating ophthalmic diseases are now conducted by such distinguished and zealous medical officers, and are disseminating ophthalmic knowledge so widely through the profession at large, that all mystery or pretensions to exclusive superiority must fall, as a matter of course.

The invaluable work before us is divided into three parts: the 1st, dedicated to the ANATOMY and PHYSIOLOGY of the eye and its appendages-the 2d, to the PATHOLOGY of the membranes, humours, and appendages of that organ; and the 3d, to the TREATMENT.

The anatomical portion occupies forty-four pages, and presents an animated, yet exceeding chaste and terse, delineation of all that is interesting to be known, or necessary to be remembered, of the structure of the parts, without wasting his own time, or perplexing the reader, by uselessly dividing, and tiresomely naming the "ravellings of minute anatomy." Into this part of the work we cannot be expected to enter. About an equal space is devoted to the physiology of the eye and its appurtenances, and to it we may apply the same observation as to the anatomical section.

The first chapter of the SECOND PART of Mr. Travers's book embraces the pathology of the membranes, and is divided into five sections, viz. on the Conjunctiva-CorneaSclerotica-Choroid and Iris-Retina. These sections we shall notice in their order.

I. Conjunctiva. After some anatomical observations on the vessels supplying the conjunctiva, as derived from two sources, the palpebral and ophthalmic muscular arteries, but very freely inosculating with each other, our intelligent author remarks, that, though in a tranquil and healthy state of the eye, little, if any, red blood is admitted into the superficial vessels, yet, under a very temporary excitement, the red fluid enters them on the sclerotic conjunctiva. It is wisely ordered, however, that the condensed connecting texture upon the cornea prevents the admission of red blood into its vessels, even under a very high degree of inflammation. Mr. Travers avers, that the susceptibility to increased vascularity of parts, under excitement, "is in proportion to the quantity of cellular texture entering into their composition, or connecting them with subjacent parts." For an elucidation

of this he refers to a comparison of the faucial and tracheal membrane with the pleura-the periosteum with the lining membrane of the veins and arteries.

The admission of red blood, then, into the sclerotic conjunctiva marks pretty accurately the progress of inflammation; while the first effect of this disease upon the cornea, is haze or dimness, depending on a loaded state of its serous vessels. This dimness is immediately removed by rebalancing the circulation, or removing the irritation destroying that balance. Transient dimness, in fact, is merely "a condition of congestion;" but, if continued for a certain time, produces a deeper and more permanent opacity, viz. effusion into the connecting texture, and thickening of the conjunctiva upon the cornea. The peritoneal, arachnoid, and synovial membranes, probably exhibit the transient and permanent opacity, in the distinct stages of congestion and effusion. The epidermis, in the state of blush and incipient vesication, forms a striking contrast to the above.

"The conjuctiva is to the cornea, what the periosteum is to the bone. It nourishes the superficial lamella; wherever it is completely detached, the exposed surface of the cornea ulcerates, and its vessels repair the breach. To pursue the analogy, the interlamellar texture of the cornea may represent the medullary membrane; gangrene therefore does not ensue but from a permanent destruction of both textures, as by blows and explosions, which mechanically disorganize; by the action of lime, gunpowder, strong acids, and other chymically destructive agents; or by the strangulation of the vessels of both textures, as in the excessive chemosis, which destroys on the same principle as the paraphymosis, or the strangulated hernia." P. 91.

The characters of local and healthy inflammation of the eye are well known, and exhibit the simplest example of the disease; but this phlogosis is much modified by certain constitutional causes or dispositions-as for instance, struma. In this case, (where it has not proceeded to change of structure) the vascularity is inconsiderable. It is marked by great intolerance of light, and, in its simplest form, is almost peculiar to children-stationary-marked by a very slight redness of the sclerotic conjunctiva-and the highest degree of morbid sensibility to light, which, Mr. Travers observes, is purely a disorder of function, never impairing the faculty of vision, though far exceeding that which accompanies the acutest inflammation to which the eye is liable.

"I attribute it," says this acute pathologist, "to a morbid sympathy of the retina with the secreting surfaces of the primæ viæ and the skin, for neither of these organs perform their healthy functions during its existence. The tongue, the index of the former, shows