the transparent capsule, which is sometimes so elastic that the operator, whose eye is not well accustomed, is in danger of not opening it in the centre, or of wounding the interior surface of the cornea. This is especially to be feared in operating behind the iris, when the lens is, at the same time, much diminished by absorption, as in children; so that the capsule moves before the needle instead of resisting it. Few cases of lenticular cataract occur, to which this method is appropriate, and in which it is adviseable to perform the posterior operation. There is more pain, more inflammation, more danger of displacing the lens than in the operation through the cornea. But when the capsule is opake and the lens diminished in bulk, either spontaneously or in consequence of former operations, so as to have receded from the pupil, the posterior operation is more eligible, as the operator readily ascertains the effect of the needle upon the capsule, and directs its movements to the best advantage; while the inflammation is always moderate in proportion as the lens is small. Indeed, in the purely capsular cataract of the adult, and the half absorbed cataract of children, it is so slight as scarcely to confine the patient. When a cataract of firm consistence has undergone a partial absorption from one or more operations with the needle, and still does not readily separate into fragments, the introduction of the needle, posterior to the iris, gives the surgeon the advantage of couching it. This I have often done, to the great satisfaction of the patient, who escapes, owing to the diminished bulk of the lens, the inflammation which occasionally follows the primary operation of couching. It was my inten tion to point out the circumstances which should determine the election of couching or extraction in the two latter species of cataract, and to shew the value of these operations relatively to each other and to that by solution, as the deliberate result of an impartial investigation of all. This I shall make the subject of a future communication.

SELECTED REVIEWS.

Practical Observations on the Treatment of the Diseases of the Prostate Gland. Illustrated by Copper-Plates. By EDWARD HOME, Esq. F. R. S. Serjeant Surgeon to the King, and Surgeon to St. George's Hospital. 8vo. pp. 360. London, Nicol, 1811.

[From the London Medical Review, for January, 1812.]

THE frequency and importance of diseases of the urinary passages, the insufficiency of the means employed for their cure, and the unchecked course which many of them hold to a fatal termination, have rendered them at all times subjects of much interest. But it is not until comparatively recent times that any thing very material has been added to our knowledge of them, or much improvement introduced into the mode of treatment. A subject which has engaged the particular attention of such men as Hunter and Desault, cannot but have been illustrated by their researches. In this country Mr. Hunter was perhaps the first who led the way to a more scientific mode of treating many of those disorders, by his valuable observations in his Treatise on the Venereal Disease. In France the subject has been taken up by Desault, who appears to have prosecuted his inquiries with the same ardour that characterised all his labours for the improvement of surgery. Of the surgeons of the present day, there is no one to whom we are more indebted for an extension of our knowledge of diseases of the urinary passages than to the author of the work before us. Mr. Home has had the advantage of a very ample experience, and it has evidently been with him a subject of particular study.

The first part of this volume consists of a republication of a paper read before the Royal Society, and thought worthy of being published in their Trausactions. It contains an ac

count of a middle lobe of the prostate gland, "which," says Mr. Home, “I had recently discovered," and "which, from the obscurity of its situation, had hitherto escaped observation."

It has been often observed that, in the latter periods of life, the prostate gland becomes more or less enlarged, forming tumours projecting into the bladder; and that the most frequent form is that of a small rounded tumour immediately behind the opening of the urethra. Mr. Home quotes Morgagni as having noticed this tumour, and adds, " it is evident that Morgagni had no idea there was any conformation of the prostate gland that could account for this tumour, and believed that it arose from the surface of the body of the gland."

The passage from Mr. Hunter, which Mr. Home introduces, is very expressive of the appearance of the tumour. "Besides this effect of the lateral parts swelling, a very small portion of the gland, which lies behind the very beginning of the urethra, swells forward like a point as it were into the bladder, acting like a valve to the mouth of the urethra. It sometimes increases so much as to form a tumour projecting some inches into the cavity of the bladder." It is added that Mr. Hunter did not prosecute the inquiry.

Mr. Home's attention was directed to this subject more particularly, from finding this "nipple-like process" very prominent in a person who had died from the disease of this part, and a bridle, extending from the middle line of the tumour to the bulb of the urethra, where it insensibly disappeared. The veru montanum; somewhat wasted, was concealed in the fold forming this bridle, which appears to have drawn the bulb towards the tumour, and shortened the membranous part of the canal. Struck with this appearance, which he supposed to have been unnoticed by others, he was led to consider it with attention. In order to satisfy himself whether this tumour arose from the disease of any distinct portion of the prostate, sufficiently detached to move independently of the rest, he

thought it necessary to examine the gland accurately in its natural state.

Mr. Brodie, as usual, undertook the dissections. In the angle between the two posterior lobes of the prostate gland, lying between the two converging points of the vasa deferentia and the bladder, and adhering to the latter, he found a small rounded substance, resembling in appearance one of Cowper's glands. It could not be detached from the contiguous lateral portions of the prostate, and yet was sufficiently distinct to be considered as a separate gland. By other dissections it was proved to be a lobe of the prostate, the substance being continued from one to the other, on the side next the bladder, but rendered a separate lobe by two fissures on the opposite surface. It was found to vary much in size in different subjects, in some being scarcely distinguishable as a glandular body; in others it was larger, more defined, and evidently blended with the lateral portions of the gland. No anatomists, he adds, have pointed out this lobe, and therefore, in whatever way they have described the vasa deferentia to pass into the bladder, they have neither anticipated, nor thrown any light on the present inquiry with regard to the middle lobe; either with respect to its natural form, or the regularly rounded shape it preserves in the different stages of its enlargement.

In the plate annexed, this middle lobe is represented as very distinct, and larger than we shall generally find it. It is certainly in some cases scarcely to be made out as distinct from the firm and dense tissue which unites the lateral portions of the prostate; and, where most distinct, it is closely united with them.

There is an unnecessary degree of parade in the manner in which this discovery is announced, especially as it was very generally known by all who had examined the structure of these parts, that there was a portion of the prostate gland, which lay behind the openings of the converging vasa deferentia, and between these and the bladder. Our readers will perhaps think still less of this great discovery, on perusing the

following passage from Morgagni. "Quod si vera ulla propago prostate addenda est, ea certè est subrotunda et renitens quasi glandula, quam cum sæpe diligentissimus incisor noster in publicis dissectionibus animadvertisset inter vesicam, et seminales capsulas, qua sese mutuo hæ jam contingunt, prominentem, et nonnunquam ad angulum quem, conveniendo, efficiunt, prostantem, nos accurato instituto examine nihil aliud esse comperimus quam corporis ipsius prostatæ particulam, non sine aliquâ fortasse in iis qui hanc habent (neque enim omnes habent) utilitate, ut puta ad easdem capsulas a compressione distentæ vesicæ defendendas, aut alia ejuscemodi, inter hanc atque illas protuberantem."*

No one from this description can doubt but that the "prostatæ propago," the "subrotunda and renitens glandula," of Morgagni, and "the small rounded substance imbedded between the vasa deferentia and the bladder," the small middle lobe of the prostate of Mr. Home, are one and the same. The figure and precise situation are well described by both, and cannot be mistaken. Morgagni thinks it is not always present; and Mr. Home, in one of the five dissections, says, that there was no apparent glandular substance, but a mass of condensed cellular membrane. Morgagni, and his "diligentissimus incisor," may in this instance be compared to Mr. Home and his indefatigable dissector. It thus appears, that what has been registered in the Philosophical Transactions as a recent discovery of Mr. Home's, was well known in the time of Morgagni, and demonstrated often in public dissections.

That Morgagni was well acquainted with the diseased enlargement of this part is no less evident. In all his dissections we find particular mention made of the prominent feature of this disease, the roundness of the tumour under different de

⚫ Adversaria Anatomica, iv. 14. And in another place, describing an enlargement of the prostate, he says, "ejusdem glandulæ subrotunda propago, in adversariis memorata, medium pariter posteriorem summumque locum tenebat."

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