for the propagation of the disease in every organ, and the failure of most operations performed for its removal.

The present edition contains the result of Mr. Abernethy's experience in the palliative treatment of cancer. It is entirely of a dietetic nature, and refers to the influence which the state of the alimentary system has upon diseases in general.

"There can be no subject which I think more likely to influence the mind of a surgeon, than that of an endeavour to amend and alter the state of a cancerous constitution. The best timed and well conducted operation brings with it nothing but disgrace, if the diseased propensities of the constitution are active and powerful. It is after an operation that, in my opinion, we are most particularly incited to regulate the constitution, lest the disease should be revived or renewed by its disturbance. In addition to that attention to tranquillize and invigorate the nervous system, and keep the digestive organs in as healthy a state as possible, which I have recommended in the first volume, I believe general experience sanctions the recommendation of a mere vegetable, because less stimulating diet, with the addition of so much milk, broth, and eggs, as seem necessary to prevent any declension in a patient's strength."

The remarks on encysted tumours, although not so full or systematically arranged as those on sarcomatous growths, contain many hints of much practical importance. These tumours consist of unorganized matter of various appearances and consistence, secreted by the internal surfaces of cysts of different textures and properties. The cysts, of course, are to be considered as the parts in which the diseased actions reside, and on that account claim our principal attention. It is an object in all tumours to know how far the cyst or capsule partakes of the diseased action, since this knowledge will determine how far its removal is necessary, and would very much facilitate the performance of operations. In many of the sarcomata the cyst appears to be merely an adventitious growth and independent of the morbid actions, for in the adipose

sarcoma, if the contents of the sac be removed, the latter will adhere and not regenerate the disease. But in encysted tumours the cyst may be regarded as the nidus of the diseased actions, and hence its removal is indispensable in the cure. Mr. Abernethy has related some cases which fully prove the truth of these remarks.

There are two other circumstances which claim our attention with regard to encysted tumours. The slightest irritation in them will produce the utmost constitutional derangement, and will often prove fatal. This will not appear very surprising, if we consider the immense surface contained in many of these cysts, and how much the constitution must sympathize with such an extent of inflammation. It teaches us also the danger of irritating wens, either of an irritable nature or occurring in irritable habits. Cysts of this nature, when exposed, are very liable to generate a fungus of so intractable a nature, that it furnishes an additional argument for the complete removal of the disease. Mr. Abernethy has related an instance of this kind, which seems very much allied to some of those cases, termed by Mr. Hey, fungus hæmatodes. He has also appended a history, which proves most strikingly the similarity of these cases with that disease which our author has denominated fungus of the brain, and corroborates very fully an opinion, which we formerly expressed, of the origin of such diseases in the rupture of minute blood-vessels.

"A young man, who was out of health, and complained of stiffness and pain in the bottom of his belly, took to his bed, declaring his inability to move about. Suddenly a swelling formed above Poupart's ligament, which rapidly increased and the skin ulcerated. A frightful fungus seemed to present itself, an uncontrolable hæmorrhage ensued. When the case was examined after death, all that bulged out could be removed by the finger or sponge, and appeared to be coagulated blood rather than fungus; and at the bottom nothing was seen but the abdominal muscles, which had that bruised or brownish appearance which Mr. Hey has described."

Few diseases have been considered more desperate than lumbar abscesses; and their remote situation, and an idea that they are universally connected with a carious state of the vertebræ, has hitherto preserved them from the interference of surgery. Mr. Abernethy's practice and observations have, however, convinced us, that they ought not to be placed on the list of incurables, and prove how far scientific investigation is capable of disarming the most formidable diseases. Lumbar abscesses are generally complicated with a carious state of the vertebræ, and the practice of Mr. Pott successfully proved, how far counter-irritation is capable of arresting this ulcerative process. Chronic abscesses are not in their nature dangerous, whether connected with diseased bones or otherwise, but become so from their magnitude, and the effects which, from this circumstance, they produce on the constitution; whence we clearly see, that the objects of surgery ought to be to prevent their increase or reduce their dimensions. In general they proceed in one tenor from bad to worse, till at length the swelling bursts, fever ensues, the patient becomes hectic and dies. The magnitude of the tumour is the cause of its bursting, and hence, in the cure of all chronic abscesses, the indications are to prevent their increase, and subsequently to promote their dispersion. Counter-irritation and an attention to the general health will often effect this, and leave the cure of the diseased bones a work of subsequent importance.

But the abscess will sometimes continue to increase, the integuments become irritated from distension, and the swelling is proceeding to burst. The question then is, whether we should allow it to open spontaneously or treat it like phlegmonous abscesses. If inflammation supervene and it burst spontaneously, or a permanent opening be made into it, the most horrible effects supervene. A violent degree of irritation takes place in the sac; the constitution sympathizes with such an extensive inflammation; the patient is feverish and generally hectic. This constitutional derangement has generally been imputed to the admission of air into the cavity of the abscess,

or the absorption of pus from it. Neither of these explanations however, appear probable; for the contact of air in an emphysematous state of the cellular membrane, or when blown into the cavities, does not cause inflammation, nor does it on ulcers in a state of disease; nor does the absorption of pus from the surfaces of ulcers and abscesses produce any constitutional derangement. The inflammation seems to be propagated from the opening throughout the immense surface of the cyst, and the constitutional derangement and fever are sympathetic with this great extent of irritation. The object therefore is to evacuate the abscess in such a manner as shall not excite inflammation. This Mr. Abernethy effects by a small puncture through a sound part of the integuments, and immediately closing the wound by the adhesive inflammation. Inflammation rarely follows this operation; the sac contracts and the subsequent collection is evacuated before the distension has brought the cyst to its former magnitude; and by a repetition of this process it is reduced to an extent which allows no dread of inflammation from a permanent opening. This practice is applicable to chronic abscesses in all situations where the extent of the cyst would lead us to dread the effects of its inflammation.

It is this treatment, which Mr. Abernethy ventured to recommend in cases of spina bifida, and which Mr. Okes so prematurely reprobated. Unfortunately for Mr. Okes, at the very time he was writing his book, and in his closet had so decidedly determined the impossibility of the practice, Mr. Astley Cooper, in his great field of experience, had actually proved its excellence in many instances. This gentleman has already committed to the press the accounts of several cases in which this treatment has completely succeeded; and the death of the patient from another cause, in one instance, enabled him to determine that contractability of the membrane, which Mr. Okes had denied. These cases furnish a most complete refutation of Mr. Okes's speculations, and prove how VOL. V. No. 17.

Q

little dependance should be placed on reasoning which is not deduced from absolute experiment.

The volume before us concludes the series of Mr. Abernethy's observations; constituting, in our opinion, the most valuable addition which has been made to surgery since the time of Mr. Hunter. Our author has pointed out a new source of local diseases; he has discriminated the innumerable affections which emulate the appearance of syphilis; he has boldly advanced the operation of aneurism to an extent, the possibility of which has been denied by many experienced surgeons; and in the present volume he has commenced the cultivation of an immense tract of disease which hitherto knew but one history and one treatment. His book is a simple narration of most important facts, and his deductions from them may be regarded as axioms in the practice of surgery. The progress which his doctrines are daily making is the best earnest of their importance, and the success of his operations is the best answer to those who have denied their possibility. If we have ventured in a few instances to dissent from him, we have only availed ourselves of his readiness "to encounter these risks, when we had it in view to bring a difficult and interesting subject fairly before the public." We are confident that Mr. Abernethy would prefer a free investigation of his opinions, to an obsequious vassalage to his authority. "To exert reason is not to revolt against authority; reason and authority do not move on the same parallel."