V.

1. A Dissertation on the Treatment of Morbid Local Affections of Nerves: to which the Jacksonian Prize was adjudged by the Royal College of Surgeons. By JOSEPH SWAN, Member of the Royal College of Surgeons, and Surgeon to the Lincoln County Hospital. One vol. 8vo. pp. 196, three plates. London, 1820.

"Non Scribo hoc temere. Quo minus familiaris sum, hoc sum ad investigandum curiosior." Cicero.

2. Tentamen Medicum inaugurale de Neuralgia faciali Spasmodica. By ROBERT MASTERS KERRISON, M.D. Licentiate of the Royal College of Physicians. Octavo, sewed, pp. 45. Edinburgh, 1820.

"Cognitis indiciis, quæ nos vel spe consolentur, vel metu terriant, adcurationes morborum, transeundum est."

Cels.

3. A Treatise on that painful Disease of the Face, called Tic Douloureux: including Practical Observations and Illustrations tending to point out not only a Plan of Prevention, but of radical Cure; with Formula of Prescription used successfully. By G. H. VILLERS, Physician-Accoucheur, formerly a Surgeon in the Army. Octavo, pp. 34. London, 1821.

THE sentiment of the great Roman orator, expressed in Mr. Swan's motto, ought especially to actuate the medical philosopher; for, in no province of human knowledge is there. greater scope for investigation than in that of medicine and its auxiliary branches. The anatomy of the nervous system, it is true, has been cultivated with considerable success by many eminent men of former and present times; but a dense cloud overhangs its physiology, and has hitherto veiled most of its laws in almost total obscurity. Of all the neurological theories that have been proposed, Mr. Swan is disposed to consider that one of the most rational which goes to the identity, or at least great similarity, of the nervous and electric fluids a presumption, he thinks, greatly strengthened by the circumstance that the galvanic influence on the nerves of an animal apparently dead, will produce the same motions in the parts to which these nerves are distributed, that were produced in them when the animal was alive. Without questioning the considerable analogy which subsists between the nervous and galvanic fluids, we are disposed to view these experiments with some degree of scepticism. A needle pricking the muscle of a dead animal, will often cause it to contract, and we consider the galvanic

shocks thrown along the nerves of a dead animal, as only so many powerful stimuli, but not by any means identifying them with the fluid, or whatever it may be which is transmitted from the brain to the muscle in the living body. The fact of the torpedo and gymnotus electricus being able to communicate shocks to other animals is much more presumptive proof than the galvanic experiments; yet even here we are hardly authorized to infer similarity of cause from similarity of effect.

The strongest proof of the analogy in question has undoubtedly been drawn from the action of secretion being renewed and carried on by aid of galvanic influence, after the nerves going to the secretory organs have been divided. But these physiological disquisitions we shall leave to the many able experimenters who are now directing their investigations towards that important point.

The sanction of the Royal College of Surgeons, as evinced by the Jacksonian prize, is in itself a passport, for the work before us, to public patronage; but we believe that the analytical sketch which we shall forthwith present our readers, will not only accelerate the circulation of the work itself, but diffuse a knowledge of its valuable contents to an extent which it would not otherwise be likely to reach.

The work is divided into fifteen chapters, the contents of which we shall not enumerate here, as we shall dip, more or less deeply, into each as we pass along.

I. The first chapter is dedicated to diseases and injuries of the nerves of sense. These, our author remarks, do not seem to suffer much from injuries and diseases or at least they do not excite so much constitutional disturbance as affections in other parts of the nervous system-yet, when once affected, they are less disposed to the restorative process than other nerves. The olfactory functions may be diminished or destroyed by the frequent application of strong odours, or by inflammation of the schneiderian membrane, or pressure on the origins of the nerves by hydatids, &c. In the case of inflammation, leeches to the exterior of the nose, cooling ointment to the interior of it, and purging medicines, are the proper means. A case is related of a man who complained of very violent pain in the forehead for many days, especially towards the right side of the crista galli, with complete loss of smell in the right nostril, that of the left remaining entire. He was bled copiously from the arm and temples, took antimonial powder with submuriate of mercury and sulphate of magnesia, besides being put on a strict regimen. By these means the pain gradually declined, and the sense of smell returned. The

functions of the olfactory, as of other nerves of sense, are sometimes so disordered as to produce unpleasant sensations, and that without any manifest cause, excepting that the functions of the stomach and associated organs are generally deranged. These functions restored, the sympathetic disorder generally ceases.

We shall pass over Mr. Swan's observations on affections of the optic nerves constituting amaurosis, since these are more fully treated of in our analysis of Mr. Travers's excellent volume.

In the following case our author had reason to suppose that there was a fracture of the base of the skull, that the petrous portion of the left temporal bone was much injured, and that the portio mollis of the seventh pair was destroyed. As the case is short, and rather interesting, we shall quote it.

"A man fell from a loaded wagon, and pitched on his head on the left parietal bone. A small wound was made, but this bone was not injured. Much blood flowed from the left ear, and a little from the right, and he became insensible. On being bled he became more sensible, but the next day he was again insensible. His pulse was eighty, and weak. Four grains of submuriate of mercury and purging medicines were given him. The third day he kept sleeping, but when roused appeared more sensible. The purging medicines had operated, and his pulse was seventy-two, and weak. Four grains of the antimonial powder and a saline draught were given every four hours. On the fifth day he became quite sensible, but had pain in his head, and was entirely deaf. On the seventh day the pain in his head had increased, his pulse was only fifty-four, and his cheeks were flushed. Six ounces of blood were taken from the arm, which relieved him. On the eighth day he continued better, though his pulse was only fifty-four. On the tenth day he kept mending, but when he attempted to walk, his legs appeared very weak. He continued entirely deaf. A great quantity of an aqueous fluid had kept constantly discharging from his left ear, and some from his right.

"On the second day after the accident the fluid was very much tinged with blood, but after that it kept gradually getting paler. On the tenth day it was quite pale. I collected some in a tea-spoon, and made it boil over a candle, but it did not coagulate, and it was saltish to the taste.

"Some months after when I saw him he could hear tolerably with the right ear, but remained perfectly deaf of the left." P. 12.

We must pass over a number of cases and observations respecting disorders of the auditory nerves, from page 12 to 29 of the work, part of which have been read in or published by the Medico-Chirurgical Society.

II. In the second chapter our author takes up diseases and injuries of the nerves of voluntary motion in general, Vol. II. No. 5.

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It is this class which principally suffers in paralytic affections, though the nerves of sense in the skin arise with the others going to the muscles. Mr. S. endeavours to account for this phenomenon "by supposing that the muscles of voluntary motion require the nerves to be in the most perfect state to enable them to act, and that a less degree of perfection is necessary for them to perform the functions required for the sense of feeling."

"When much pressure," says he, "is made on the medulla spinalis, as in most fractures of the spine, all the nerves below the injury lose entirely the power of communicating either sensation or motion to the parts to which they are distributed. When the pressure has been rather less, and some power of transmitting the nervous influence is left, it is sensation in different degrees that is produced. When the pressure is still less, there is along with sensation a feeble power over the muscles; and these circumstances, I think, go to prove what I have stated already, viz. that when the functions of the nerves of a limb are impaired, as in paralysis, they must all equally suffer; and the apparent difference of the effects of the paralysis in the several parts affected by it, arises from the different degrees of perfection necessary for enabling each of them to perform their functions."

31.

It sometimes is the case, but comparatively rare, that the nerves of sensation suffer from paralysis, while those of voluntary motion, though arising from the same trunks, are little affected. When this occurs, our author thinks that such an alteration takes place in the skin as prevents the proper exercise of the nerves distributed to it. We know, indeed, that the sense of feeling will vary according to the state of the skin, and particularly of the blood-vessels.

"In further support of the opinion, I might mention the different constructions of the organs or parts themselves necessary for furnishing the nerves with a proper supply of blood; but I will merely describe the curious structure in the nose, which appears to me to be formed for the perfection of the sense of smell.

"Beneath the Schneiderian membrane there are numerous sinuses, and many of them of considerable size, which have frequent communications with each other, and appear to be composed of a very thin and inelastic membrane, which is very strong, and perfectly smooth in the inside: within the sinuses are contained very delicate and extremely elastic vessels, which may be called veins, as they appear to be filled with venous blood; and by their being thus situated within sinuses of a determinate size, they are capable of being distended to a certain degree only; which provision is necessary, as their extreme delicacy would otherwise either endanger their very frequent breaking from over-distention, or be the cause of much injury to the very delicate nerves by a too great pressure that would be thus made on them.

"This structure, I have no doubt, generally exists in animals, and may be very satisfactorily demonstrated in the horse; and it must, I think, appear to any one examining its peculiarities attentively, that it was not formed merely for returning the blood from the nose, but that it was made for distending the Schneiderian membrane, so as to give it a proper degree of tension to enable the nerves to receive more acutely the impressions from the odorous particles when applied to them; exactly in the same manner that it is required for the nerves of the penis to produce their peculiar sensations, that the parts connected with them should be properly distended ith blood." 34.

III. Passing over physiology, we come to the pathology of the nerves of voluntary motion, in the 3d chapter of the work before us. These diseases are of two kinds, active and passive, or painful and paralytic. In the former class there is an increased action of the blood-vessels, and also of the animal temperature of the apparent seat of disease-in the latter class there is a contrary state. In the following sentiments we entirely agree with our intelligent author.

"Those local complaints which appear to originate spontaneously, or in some cases where a slight wound has been inflicted, I believe to be only symptomatic of a general irritability of the brain and nervous system. The almost constant failure of topical remedies, and of the division of the affected nerve, must lead to the conclusion that the cause of the local diseased action, or primary affection, must reside in some other part of the body; and if we inquire into the causes of the local active affections of the nerves, it will be found that the atonic state of the body, or whatever tends to render the brain and nervous system irritable, will generally be found the most frequent." 38.

This irritability of the brain, Mr. Swan observes, is produced by any excessive exertion of its powers, such as too great attention to business, the depressing passions, irregularity of living, inordinate use of fermented liquors, disordered states of the digestive organs, &c. The stomach being the centre of sympathies, there is no part of the body that is not liable to be affected by the state of this organ. "But why part of a nerve should suffer without any alteration in its organization is almost inexplicable." On this sentiment we would remark, that we are by no means authorized to affirm that there is no actual, because no apparent, alteration of structure in a nerve; and moreover as the pain is generally referred to a place distant more or less from the seat of irritation or lesion, we cannot expect to find the alteration of structure at that part, if it at all exist.

IV. The fourth chapter is dedicated to those painful affec