wounded nerves. A young man received a stab near the knee, at the inferior and inner part of the left thigh, in the course of the saphena vein and nerve. After considerable hæmorrhage, tumefaction and fever supervened, the affected extremity being very painful. When these symptoms had abated, a trembling and nervous agitation of the leg and thigh came on, and resisted all attempts at alleviation. M. Sabatier thrust a sword through the thigh of a dead subject,, in the same direction, and found the saphena entirely divided, and the nerve cut half through. He therefore advised the cautery, to which the young man would not submit. The patient continued lame for some months, but, ultimately, though slowly, recovered. We must pass over Mr. Swan's remarks on tetanus, as nothing particular occurs in that portion of the work.

XII. & XIII. The twelfth chapter is on ligature of nerves, and the thirteenth on compression of them. The former is short, and does not contain any thing novel. The thirteenth chapter contains several interesting cases, but we find our limits overstepped, and shall only be able to make one extract as an example. The case is introduced by Mr. Swan to show that when there has been a paraplegia, it is necessary to draw off the urine, not only on account of the bladder, but because the over-distention of this organ causes pressure on the nerves, and thus tends to prevent their recovery.

"Nov. 6, 1819. Mr. F., aged twenty-five, had the heartburn, after which he ate a hearty dinner of beef and apple dumpling, and the heartburn went off. Soon after he carried a weight of wood for some distance, which produced the heartburn again, and he was obliged to lie down on the damp ground from feeling so unwell. - After he had laid a little while his legs began to feel weak, and he had much difficulty in walking home, as the powers of the muscles kept diminishing, and at last they entirely failed. The bladder, and also the sphincter ani, lost almost entirely their muscular power: the paralysis extended from the pit of the stomach downwards : he had no power of moving any of the muscles: he felt well, except being thirsty, and had a good appetite: when the bladder was very much distended he felt pain, but it was not violent: the feeling of the skin was so far perfect as to render him sensible of the slightest touch; but moderately cold things applied to the skin did not feel cold, nor did hot things feel more than just warm; his sensations of heat and cold with the upper extremities were perfect, and very different from those experienced by the lower.

The symptoms in this case are slighter than those usually met with where pressure is made on the medulla spinalis, as in fractures of the spine; and, I think, prove, beyond all doubt, that the nerves

have all the same degree of feeling, but that the various agents that. call them into action act in a more easy or difficult manner. The sense of touch is by far the most mechanical; moderate degrees of heat and cold are less active agents; and the will still less."

XIV. Mr. Swan's fourteenth chapter contains numerous experiments on animals, for the purpose of ascertaining the process which nature employs for repairing wounds of nerves. Into these experiments we cannot enter, as they require to be read with care, and cannot be abridged. From the concluding chapter we shall make some extracts.

"It will be seen from these experiments, in the first place, that after a division of a nerve, the extremities of the divided portions become enlarged and more vascular, but especially the upper portion; and coagulable lymph, having the appearance of white of egg, is effused, which soon becomes vascular. In a few days the coagulable lymph from each portion becomes united, and anastomoses from between the blood-vessels; the coagulable lymph gradually assumes a firmer texture, and the number of the blood-vessels diminishes, and the newly-formed substance appears to contract, like all other cicatrices,so as to bring the extremities of the divided portions nearer and nearer to each other. It is difficult to determine from an experiment on the limb of an animal the exact time at which the nerve again performs its functions. In eight weeks after the division of the sciatic nerve, I have observed a rabbit to be in some degree improved in the use of its leg, but at the end of eighteen weeks it was not perfect. When the nerves of the leg of a horse have been divided just above the foot, they are sufficiently restored to perform their functions in a very great degree in six or eight weeks; but it must be observed that these nerves are only formed for sensation, and it is very different with the nerves of voluntary motion." 184.

Though this is the general way in which a divided nerve reunites, yet the reunion is sometimes accomplished by granulations. It appears also from Mr. Swan's experiments, that when a portion of nerve is cut away, the same restorative process is set up as when there is merely a division of the nerve; but the divided portions appear never to be again restored to the same size as the original nerve. The following curious circumstance we shall here quote.

"A horse had been lame for two years, at the end of which time an inch of each nerve going to the foot was cut out; after this he went very well for six months, when he again became lame, and continued so five months; at the end of this time, he appeared to suffer such dreadful pain that he was killed. At the time he was operated on, it was supposed that the disease was the same in both fore legs, so that portions of the nerves of both of them were removed.

"On examining the legs after he was killed, one was very much

swelled, especially at the foot, where matter was discharged by several sinuses leading to the coffin bone, which was quite carious. "On further examination, the nerves of this leg were found to have reunited, and the new-formed substance was very large, and appeared to have the same structure as that which forms the bond of union when a nerve has been simply divided. The nerves, above the place where they were divided, were found to be much larger than those of the opposite leg in the same place. In the opposite leg, in which there did not appear to be much disease, the nerves had reunited, but the bond of union was not so large as in the other leg.

"From these circumstances, it appears to me that the functions of the nerves were again performed, through the medium of the newformed substance; but I am informed this is not usually the case when so large a portion as an inch of the nerve has been removed; and this circumstance shows, that in this instance it must have been owing to the irritation occasioned by the disease in the foot." 186.

Another conclusion deduced from our author's experiments is, that when a nerve has been included in a ligature, the parts to which it is distributed are deprived of sensation and motion, in the same manner as when the nerve has been divided. Immediately after the application of the ligature, the vessels of the nerve begin to enlarge and become numerous, coagulable lymph being, in the mean time, effused from the nerve above and below the ligature, through which the vessels shoot and anastomose. The ligature becomes incased by the lymph. Immediately after it is cast off, the separated portions of nerve begin to unite, and the process of reparation goes on until the union is so complete, as to enable it to perform its functions.

But we must conclude. We hope we have done justice to Mr. Swan's work, which we conceive to be highly creditable to his zeal and talents. We trust that he will persevere in the investigation of abstruse points (of which there are, unfortunately, too many) in medical science, and for which investigation Mr. Swan's abilities appear to be well calculated. The plates of this work are very well executed.

VI.

A Treatise on the Epidemic Cholera of India. By JAMES BOYLE, Surgeon of His Majesty's Ship Minden, &c. &c. In octavo, pp. 75. London, 1821.

THE ravages of the plague, at least in modern times, have produced nothing like the destruction of this Epidemic Cholera; and unfortunately it is not the epidemic of a season, but that of a series of years, of which the termination is not

yet in view. Of its etiology we know nothing-or next to nothing; its pathology admits of doubt; and its treatment is but too often unsuccessful. Under these circumstances, we must be contented with such gleams of light as observers have been able to throw upon the nature and management of this formidable disease.

The author of the little volume before us is a meritorious young naval surgeon, who, whilst serving on board His Majesty's Ship Minden, with the Commander in Chief, in the East Indies, had to treat many cases of the Epidemic Cholera, and has here offered the results of his observations and reflections to his brethren at large. We have lately devoted so much space to the consideration of this wide-spreading disease, that we must be very limited in our analytical notice of the tract under review.

Mr. Boyle thinks that more depends on combating casual symptoms as they occur, in this disease, than on any systematic mode of treatment. Our author makes many judicious observations on the remote causes of Indian Cholera, especially drunkenness, marsh effluvia, and constipation of the bowels, sustaining his remarks by appropriate cases. His post mortem investigations do not materially differ from those which we have given an ample account of in this Journal. The following fact has been very generally confirmed by all accurate observers.

"It sometimes happens, that patients despaired of, have a critical evacuation of viscid bile, exactly resembling that which has been noticed in the gall-bladder of those who had died of the disease with obstruction of the biliary ducts. When this circumstance takes place, the patient invariably recovers; and I have known it to occur three or four times, in cases where the pulse had been almost imperceptible for twenty-four hours." P. 51.

Bleeding, Mr. Boyle thinks, is a remedy applicable only to the milder cases of this destructive cholera. Before reaction he considers the remedy useless, if not pernicious;-after that process has taken place, he imagines the original disease no longer exists.

"The great extent to which mercury has been carried of late years by the first practitioners, and it having now gained the ascendency of popular opinion over vulgar prejudice and inconsistent objections, has a just claim for consideration as a remedial measure in the management of this complaint. The universally acknowledged circumstance of the absence of bile in bad cases of Cholera, and the more than idea that mercury acts specifically on the liver and biliary system, are also strong incentives in favour of its use. Fatal cases, however, but too frequently occur where calomel is rejected as fast as it is given; or if retained, is found on examination after death,

to have insinuated itself between the ruga of the stomach, perfect in appearance, and without having had any effect whatever. Mercury, therefore, ought not to be depended on in this disease as long as nausea and sickness of stomach prevail, and to restrain which, by sedatives, appears almost impossible in severe cases, till all sensibility be destroyed, when it matters not what is given." 56.

The warm bath, he observes, in dangerous cases, is always advisable; "but measures of greater importance should be actively employed during its preparation." Mr. Boyle never observed any benefit from the bath, unless it was so graduated as to make the patient complain of its heat.

"When the bath is of such temperature as to be only agreeable to the person, the remedy appears altogether inert; but when, from heat and the patient's sensibility, remonstrance and even force is necessary to keep him in it, the result is usually favourable." 57.

Our author remarks, at page 58, that "the grand, primary, and most essential object in the treatment of cholera morbus is, to restore the balance of the circulation as quickly as possible." This is, as he observes, a general opinion; but unfortunately the restoration is not so easily effected.

"The constant nausea and irritation of stomach, which is observable in the early stages of this complaint, without full or violent vomiting, simply spouting up, as it were, any thing swallowed; the obstruction of the biliary ducts observed in dissection, and a general want of success in practice; induced me to embrace ideas pecfectly new on the subject. The obstruction of the biliary ducts I looked on as a source of irritation to the nervous system generally, and the nausea, and sickness of stomach, as an effort of nature to free herself of an unaccustomed evil.

"In accounting for the causes of this disease, it has been observed, and with great justice, that when, from the exertions to vomit, bile makes its appearance, a favourable prognosis may be formed. Now, if the appearance of bile be a salutary one, (and it certainly is,) why not favour the progress of its formation, instead of obstructing its passage by the administration of sedatives. We know of nothing which will increase the secretion of bile so quickly or so effectually as the act of vomiting; we also know the sympathy which subsists between the liver and stomach, and that derangement of either organ will more or less affect both. It is evident, then, that the gastric derangement peculiar to this disease, is not only indicative of the existence of lurking mischief, but directly points to the treatment. Further, of all the cases of which I have seen or heard, there was not one fatal termination after bile had, in any way, or by any means, made its appearance." 61.

Reflecting on these circumstances, our author was led to try emetics as the most likely measure to answer the various purposes of clearing the stomach, removing obstructions of