ing part of the work. In this great city, all who are desirous may have access to excellent museums, and have every facility of examining diseased appearances. To these, drawings are of minor importance. But we cannot too strongly praise the plan of illustrating diseases, attended with evident morbid structure, by a well selected series of plates, as it is extending in some degree the advantages of a museum to many who have neither the means nor the opportunity of personal inspection. They so much simplify and elucidate verbal histories, and leave an impression so much stronger than the best written description, without such accompaniments, can do, that we do not hesitate to rank them as means of very great utility in promoting a more general and a more accurate knowledge of disease. The rest of the work is occupied by voluminous tables of the quantity of water drawn off from two patients who laboured for a considerable time under a disease of the prostate gland. "They are intended to show the irregularity of the secretion of the kidneys, in what may be considered as a state of health respecting these organs." The latter point may, we think, well be doubted. Most of the observations in this work are founded on experience; and are confirmed and illustrated by cases and dissections. These we regard as a very valuable part of the volume, as conveying much useful information, and entering into many details which could not be so well delivered in general precepts. And it may be said, that in most instances in which we have general histories of diseases followed by the relation of cases, that it is from the latter the truly attentive reader derives the most accurate and therefore the most useful knowledge. This, we think, will be admitted by those who have sought to obtain a more intimate acquaintance with the distinguishing symptoms of diseases, by comparing written accounts with what they observe during their actual occur rence. There is an air of importance and authority in Mr. Home's style of writing, which must always be displeasing to such as value a book more for the matter it contains, than for the name of the author who composed it. This spirit is to be traced in some parts of the present work: but it appears to arise from a consciousness of his knowledge of his subject, a knowledge which in this instance we believe he eminently possesses. We submit to it therefore with far different feelings from those we have experienced in examining some of his physiological speculations. Surgical Observations on Tumours, and on Lumbar Abscesses, By JOHN ABERNETHY, F. R. S. &c. pp. 222. London, 1811. [From the London Medical Review, for October 1811.] THE word, tumour, Mr. Abernethy confines to such swellings as arise from some new production which made no part of the original composition of the body; and by this definition he excludes from his arrangement the majority of those diseases which nosologists have placed under this title. Tumour has generally been understood to designate any preternatural enlargement discoverable in any part of the body, and it has therefore included those growths of bones, joints, glands, &c. which would otherwise find no station in nosology, although they may justly be considered as morbid affections. Mr. Abernethy's definition cannot therefore be said to comprize the whole class, but merely a particular order, of which he has pointed out the species and varieties. Indeed it is not a little curious to observe the different significations in which modern writers have employed this word tumour. Mr. John Bell defines a tumour to be, "a mere accretion of nutritious particles in skin, bone, gland, or muscle, according to the nature of the part;"* whilst Mr. Abernethy applies that term exclu Bell's Principles of Surgery, Vol. S. p. 18. sively to diseases of an opposite origin, namely, to such growths as formed no part in the original composition of the body. We are obliged also to dissent from the doctrine which Mr. Abernethy has espoused, as illustrating the formation of morbid growths. Mr. Hunter found a clot of blood adhering to the surface of the peritoneum, by a slender neck half an inch in length; and Mr. Abernethy having met with a pendulous fatty tumour growing from the same membrane, concludes that it originated from a similar extravasation. The vessels are supposed to have shot through the narrow neck, and organized the clot of blood, which thus becomes a living part and increases to an indefinite magnitude. Now, however imperfect our evidence may be, to prove that extravasated blood never becomes the matrix of vessels, we must assert, that we do not know a single circumstance which substantiates the opposite opinion. If extravasated blood ever becomes the matrix of vessels, we should not expect to find it so universally and completely absorbed in the cavities of aneurismal sacs, and in extravasations in general; but should rather expect that such depositions would become living parts, and grow to indefinite magnitudes; whilst the vessels that shot into them would determine the nature and progress of the organization which had thus become established. But the fact is, that effusions of coagulated blood, instead of becoming organized, produce the same effects in the animal body as foreign substances in general. If in moderate quantity, they are generally and speedily absorbed, but if to a greater extent, or diffused amongst the surrounding parts, a degree of irritation is excited which terminates in suppuration, and the extravasated fluid is thus discharged. Besides, the common means of detecting organization, discover no vascularity in these depositions, even in their most concentrated state, and when they may be supposed to have existed a considerable time, and in contact with living parts. It is impossible to inject the firm and fleshy coagula of an aneurismal sac, and if an amputated limb be minutely injected, it will be impossible to detect organization in the plug which extends from the end of the vessel, whilst the lymph effused from the edges cut by the ligature will be red and highly vascular. If the time then have been sufficient for the propagation of vessels in the effused lymph, we think it but fair to conclude that the same changes would have taken place in the plug of coagulum had it admitted of them; and the rapidity and uniformity of the absorption of this plug furnish to our minds some evidence in favour of its non-vascularity. Neither physiology nor animal chemistry have yet pointed out the difference between that lymph of fibrine which is deposited by extravasated blood, and that effusion which takes place from wounded or ulcerated surfaces. The peculiar organization and changes which are however indispensably requisite for the production of the latter, would indicate that it is widely different from that deposition which is the result of simple extravasation. The constancy and rapidity with which vessels are propagated into the lymph which is secreted during inflammation, are evinced both in the union of divided parts and the formation of granulations; whilst extravasated coagulum not only interrupts these salutary processes, but even will exist for a great length of time without affording the least evidence of vascularity. It is that lymph, therefore, which is secreted during inflammatory action, that appears to us to form the sole matrix of vessels, and if we can but imagine it effused into the cells and cavities of the body, we shall at once arrive at the origin of morbid growths. The structures from which the vessels are propagated determine the organization of the lymph, and the tumour generally partakes of the structure of the parts from whence the vessels originate: thus, in the adipose membrane fatty tumours are formed; in the neighbourhood of bones, osseous ones; of joints, cartilaginous ones, &c. If we consider the healthy structure of the parts in which tumours arise, we shall be able to account for many circum stances in their formation; for morbid growths cannot but be regarded as accumulations of natural structure modified by peculiar actions. Tumours which form in glands approximate to the structure of those organs, being generally firm, solid, and highly vascular; whilst those that originate in the cellular membrane are frequently cystic and divided by septa. It appears to us, that an examination of the different tissues in which tumours grow, will better explain the formation of cysts, than any arguments which can be deduced from the effects of pressure, since there are often tumours of immense size and great weight which are involved in no cyst. Many also of inconsiderable size are contained in strong coats, which appear to us to have their origin from the peculiar structure in which the nucleus of the tumour was deposited. The prolixity of these observations will be forgiven by those who attach any importance to the medical treatment of these diseases. We have seen that their origin is in an inflammatory action, producing an effusion of lymph; and hence their treatment must consist in obviating this increased action, and subsequently exciting the absorption of the matter already deposited. The diminution of arterial action, by the abstraction of blood and heat, will be found best calculated for the fulfilment of the former object, and the latter is to be effected by the use of stimulants and counter-irritants. The timing of these, however, is a matter of considerable difficulty and of the utmost importance; for, if employed before the inflammatory action has fully subsided, they will increase rather than diminish the accumulation. "Both reason and experience equally demonstrate the impropriety of using the stimulating plan, till the disease is first tranquillized and in a degree subdued. It is reasonable to expect the stimulating measures will increase the actions, which are going on in the diseased part; and experience proves that diseases are often increased by those very means which, had they been employed at a proper time, might have effected their cure." That class of tumours which consists of substances of new |