Page images
PDF
EPUB
[blocks in formation]
[ocr errors]
[blocks in formation]

plan prevented him from afpiring to the he never, on the other hand, diiguts the bathos. We are perfuaded that the public a modern verfion of fome of our beft meMr Rofe. We are the more certain of this, ad the notes to Amadis with very great fatifthem a very great compliment, indeed, when refemble, in lightnefs and elegance, though not omation, thofe of George Ellis to Way's Fabliqux.

rvations on Crural Hernia; to which is prefixed, a Gent of the Varieties of Hernia. Illuftrated by Engravings. xander Monro, Junior, M. D. F. R. S. E. and Profeffor of and Surgery in the University of Edinburgh. 8vo. pp. 120. man & Rees. 1803,

often difficult to judge with perfect impartiality of the work or one who comes recommended to us by fo many extrinfic As to refpect. Our expectations are naturally influenced by the aation and opportunities of the author, and have an unfortunate dency both to enhance his merits and to aggravate his defects. if the book correfpond on the whole with the anticipations we have indulged, we give the author full credit for every incidental difplay of genius it may contain, and dwell with fatisfaction on every enlightened fentiment and judicious remark. But if, on the other hand, the general ftrain of the performance be rather below what might have been expected from the itate of the fcience, and the opportunities of the individual, we foon become unufually quick-fighted to all his imperfections; and can scarcely diveft ourfelves of a certain portion of irritation and difiatisfaction, that

would

would not perhaps have been excited by an anonymous publica

tion.

- The work before us is the first production of the Profeffor in the highest branch of the medical department in the University of Edinburgh and from an author in this fituation, holding at his command all the refources of a great national museum, and almost the whole combined information of the country, and engaged to maintain not only his own reputation, but that of the fchool in which he teaches, it was certainly natural for us to expect a work, tich in obfervation, and splendid in execution. If any of our readers fhould take up the book, as we did, with thefe impreffions, they will probably foon come to comprehend the feelings of difappointment with which we proceeded in the perufal of it.

We willingly confefs, however, that a little more confideration has convinced us of the folly of meafuring this production by fo lofty and gigantic a ftandard; it is but juftice to recollect that it is the work of a young man, to whom every thing cannot be at once familiar, and who is laudably anxious to give fome public and early proof of the induftry by which he is to fhow himself worthy of the fituation to which he has been elevated. We are perfuaded, indeed, that it is by this meritorious folicitude alone, that the author has been induced to venture before the public with a treatise on so important and delicate a fubject, and are therefore disposed to admit of every apology for the imperfections which it may be our duty to point out in it.

The work before us profeffes to treat particularly of Crural Hernia, and to fet out with a fyftematic explanation of hernia in general. It made its first appearance, we understand, in the Royal Society of Edinburgh, and is now laid before the public, with all thofe corrections and improvements that may be fuppofed to have been fuggefted by the remarks of that learned Body. If we were inclined to give a fhort and specific character of the book, we should say that it confifted too much of a feries of unconnected obfervations, and contained rather an oftentatious display of the author's acquaintance with rare and extraordinary cafes, at the fame time that they are scarcely ever detailed in such a manner as to communicate much inftruction to the reader. It is chargeable alfo, in fome degree, with a fault that is more common and more baneful in books of medicine than in works of any other defcription; we mean, that jealous partiality with which an author magnifies any little original remark or hint of a theory into a doctrine of difproportionate magnitude, and dwells upon it with a degree of complacency and copioufnefs, which he is often obliged to compenfate, by retrenching fome of the most important parts of the fubject.

In a fubject, however, of this great and terrible importance, where the lives of multitudes come fo frequently to depend on the

decifion

decifion and dexterity of the furgeon, we cannot content ourselves with these general obfervations, but must be allowed to go fomewhat more minutely into the doctrines and obfervations of the author.

Paffing over the few introductory fentences, we are somewhat abruptly arrefted by this general definition.

By the word Hernia, is generally understood, in the language of furgery, an external tumour, formed by a protrufion of the bowels through one or other of the openings through the abdominal mufcles, where the umbilical, fpermatic, or crural veffels pafs out, or round li gament of the female uterus.'

This definition, we are afraid, will not be found to be very accurate. A hernia is not an external tumor; nor is it formed by the bowels protruded through one or other of the abdominal mufcles. In many instances, it is not external; nor can it be said to form a tumor at all. It is produced by the preffure of the muscular parietes of the belly. The mufcular fibre acquires ftreat ftrength by action; and the protrufion, therefore, takes place betwixt fome of the tendinous expanfions: and, often falling down betwixt the womb and rectum into the vagina, through the obturator ligament, betwixt the fucro-ifciatic ligaments, or through the central tendon of the diaphragm, the protruded part is ftrangulated. But there is fomething of more importance than even this palpable incorrectness of the definition. A hernia may take place under the crural arch; yet there may be an utter impoffibility of deciding on the cafe by the tactus eruditus. There may be no tumor, while yet the hernia is of that kind in which the fymptoms run a rapid course, and the patient is foon beyond the reach of affistance.

Dr Monro makes a divifion of hernia into acute and chronic. In the former (he obferves) the difeafe comes on rapidly, and is the immediate refult of violent muscular exertions: In many instances, he informs us, it creates a violent degree of pain, and foon proves fatal, from ftrangulation and inflammation of the bowels. In the latter, the bowels are gradually protruded, are eafily returned, and remain down without ftrangulation; so that fuch hernia have even continued for life without great inconve nience.

This divifion of the subject is fo far good; but it does not prefent a perfect or impreflive account of the real diftinctions of hernia. It does not mark the cause of this diftinction, nor does it lead to the deductions which are truly useful in practice. A better diftinction is, to mark where there has been predifpofition, andanunufual laxity of the openings of the abdominal tendons; and

where,

where, on the other hand, there has been little or no imperfection in the parts, but where the hernia has been produced by great violence and ftraining. If, for example, after a fevere and long continued engagement at fea, a young, robuft, and healthy lad, be fuddenly bent down with extreme and enervating pain, and a small, firm, and unelastic tumor be felt in the groin; he is in the utmost danger, for the opening is fmall. The violent ftraining upon the rope, and at the fame time an attempt to throw out the carriage of the gun with his foot, has brought down a small piece of the gut. In this cafe, the attempt at reduction without incifion, will often fail; nay, it will moft probably aggravate the fymptoms, and the inflammatory stage will quickly lead to gangrene, Suppofe again that a groom, ftout, healthy and active, leaps into his faddle with so fudden an exertion as to bring down a hernia; it has the fame character, being small, hard, painful, and dangerous, .. Opposed to thefe cafes, is that of predifpofition, where there has been no violence. A boy has had a tumor from his infancy; or the patient is a man advanced in life, of a fat and relaxed habit; he has felt a fulness in the groin, which has increafed gradually, but fubfides when he lies down at night; it makes a flow grogrefs, and the fymptoms are mild, and by no means alarming; and when, from the irregularity of his bowels, or other accidental circumstance, he requires the affiftance of a furgeon, the hernia is eafily reduced. Thefe are the extreme cafes; and by studying the cause, and attending to the degree of violence, the hardness or foftnefs, and elafticity of the tumor, and the urgency of other general fymptoms, the furgeon will in general be able to form a judgement of the propriety of reiterated efforts to reduce the hernia by the hand, or the danger of violence from this rough manuifm, and the neceflity of incifion,

The danger to thofe who have long laboured under the inconvenience of a hernia, and who wear a trufs, is, that by the compreffion which is neceffary to fupport the parts, there is produced fuch a degree of callofity or rigidity of the furrounding cellular membrane, with thickening of the neck of the fac, that when, by fome unufual exertions, the hernia defcends either partially or entirely, the patient comes nearly into the fituation of thofe in whom hernia has been produced without any predifpofition to the disease, and in whom a fmall portion of inteftine has defcended into a narrow and contracted paffage. When, on the other hand, the bowels are allowed to remain down, the tumor increases from day to day; and there is danger of ftrangulation, from the gradual thickening of the neck of the fac; from fome strain, and confequent inflammation and fwelling of the cellular membrane, or condenfing and conglomeration of the omentum;

from

from irregularity of the action of the inteftine, included in the hernia; or from collections of indigeftible matter within it.

The most important fection of a treatife on hernia, must be that which relates to the fac; because all the fpeculative points, of chief confequence, are connected with this department of the subject; and it is here that the furgeon has to encounter the greateft difficulties in practice. But, inftead of finding, in this treatise, a learned, comprehenfive, and practical view of this fubject, we meet with nothing but the wanderings of a mind led aftray after curious and ftrange things, without any fober impreffion of what is truly useful and important. We learn, here, that the peritoneum forms the herniary fac; but we are not informed how unlike to the internal peritoneum the fac of a hernia becomes: We are not informed how it connects itself by adhesions; how it is obfcured by the condenfing of the cellular membrane, and the attachment of glands; how the ring and fac coalefce; and how difficult it often is to distinguish their limits. We find that our author has feen thick facs and thin facs, and facs through which the vermicular motion of the inteftines could be diftinguifhed: he has feen alfo the transparent fac of an umbilical hernia! We can believe that he has feen much; but we fhould have been better pleased, if he had pointed out to us the refults of his extenfive obfervations, and either traced the analogies by which thefe varieties are connected in the general fyftem of pathology, or indicated the advantage that practice is likely to receive from his flight notice of thofe rare and extraordinary cafes.

We have been delighted with the difplay of morbid anatomy, which the mufeum of Mr J. Hunter affords; while we were chagrined and difappointed with the imperfections of the hiftories that are now to be obtained of thefe important cafes; doubly important, from having been under the obfervation of fuch a man. We did not think, however, that Dr Monro would have had recourfe to this collection, without preffing neceffity; and we cannot help fuppofing that he has been rather unfortunate in his felection of a cafe. For, from the engraving with which we are here presented, and from the expreflion of Mr Hunter, in which he fays, it is an example of the manner in which a hernia may be cured, or the mode' in which an old hernia is formed, we fhould fear that our author has mistaken the cafe. There is no fuch thing as an old hernia, in the fenfe in which we fpeak of an old coal-pit; and we conceive, that an old herniary fac muft have been meant. In this view, the plate is intelligible; for it is a fac inflamed and adhering, fo as to prefent several compartments. We cannot vouch for the accuracy of this interpre tation; but merely recommend a fecond examination of the preparation; for, to confider this cafe of Mr Hunter as a collection

of

« PreviousContinue »