"For a long time, the opinions of Dessault exercised great influence and a most imposing authority in all the schools of surgery, which did not escape the impress of the seal of that age, when physical and mathematical sciences everywhere so much predominated. Without alluding to the art of war, which then occupied the attention of the whole world, it is worthy of notice that the study of Chemistry and Natural History quite absorbed the minds of all educated persons these branches aspired to the supreme rank in general science; and Operative Medicine sought to assume a like pre-eminence in the medical hierarchy. Surgery, thus separating itself completely from the other branches of medical science, was then unwilling to recognise anything but material facts, geometric demonstrations, and mechanical processes and contrivances; the methods which it employed, so far from being more simplified, became every day more and more complex by a luxe' of instruments and apparatuses, which were in reality good for nothing else, save only to encumber our professional armamentaria. Surgeons knew, or seemed to wish to know, nothing but Anatomy and Surgery; every one sought to distinguish himself in these two branches-the most important, it is true, but not the only positive or essential, departments of the Healing Art. Then was truly the epoch of Anatomical Surgery. If we open the works of Sabatier, Lassus, Percy, Pelletan, Boyer, and Petit, we find in every page of their writings that the classical surgery of this period was founded almost exclusively on exact, and even minute, Anatomical data; and we seldom or never meet with any allusion to medicine, any happy application of physiological truth, or any comprehensive therapeutic views apart from mere mechanical instrumentation.

"The fine genius, however, of Bichat, prepared the way for an epoch of reform. Without abandoning the path trodden by his Cotemporaries, and without renouncing the study of anatomy and its immediate application to operative surgery, this celebrated man clearly perceived that it was high time to bring medicine and surgery more closely together, and no longer to isolate the material study of our organs from the appreciation of their physiological phenomena.

What Bichat had partially foreseen and pointed out, some of his cotemporaries were not long of carrying into effect, to the great advantage of the art, and in the genuine spirit of the unity and indivisibility of medical science. The young surgeons of this period were, every one of them, either public teachers, or authors of treatises on Physiology; and it was not until they had acquired a reputation as anatomists and physiologists, that they devoted themselves, with an indefatigable ardour, to the pursuit of Operative Medicine.

"Thus Dupuytren published at the same time his Theory of the Fractures of the Fibula,' and his beautiful Report on the Yellow Fever and on Contagion.' If, on the one hand, he invented his Enterotome, on the other hand, he made us acquainted with his researches on Respiration, on Absorption, and on the Movements of the Brain; and thus it was that, if he was the first Operator of his age, he was not less distinguished as the founder of pathological anatomy.

"Richerand, too, discussed at one and the same time the subject of fractures of the thigh-bone, and the medical treatment of Ulcers; and, if he examined with great zeal the best plan of performing partial amputation of the foot, and was the first to excise diseased ribs, it is equally worthy of notice that he has left us excellent Monographs on Scurvy and on Scrofulous Affections. He is the author, every one knows, of a most interesting work on Physiology, on the one hand; and of an elaborate Treatise on Surgery, entitled Nosographie Chirurgicale,' on the other.

"Delpech and Leveillé, in their Medico-Chirurgical Researches on Necrosis, Aneurisms, Hospital Gangrene, Pyogeny, and Gymnastics applied to the general treatment of diseases, have trodden the same path, and contributed to the production of like results.

"Our illustrious preceptor, Professor Roux, in his Miscellanies of Surgery and Physiology, has discussed the various topics of fibrous tumors of the Uterus, and the phenomena of Continuous Inflammation, of Wounds and Sympathetic Affections, of Hernia and the process of Secretion. It was he who devised and first performed the operation of Staphyloraphy; and to him we owe an excellent memoir on the diagnosis of chest complaints by abdominal pressure.

"These distinguished men may be considered as the leaders or chiefs of the Epoch of what may be called Physiological Surgery-which was dominant in the schools, when the publication of Broussais' celebrated work, Doctrines Medicales,' came to give another impulsion to the system of reform, which was at this period rapidly advancing to its fulfilment.

"The start being once given, every one seemed ready to reply to the appeal that was now made to him. Medical education became much more general and complete, and all surgeons manifested an ardent wish to escape from the narrow circle in which they had been so long confined themselves. They now better understood and appreciated the many resources of nature; and, in cases apparently the most serious and desperate, they began to learn to trust more to the curative effects of these resources, collecting together with great industry and zeal numerous observations which served to give support to the new medical doctrine, in its application to the study and treatment of surgical diseases. They were less desirous to innovate than to make perfect, and less ambitious of operative success, than of fortunate cures obtained without the infliction of pain or the effusion of blood. The greater the progress that was made, the more confidently was it hoped that the number of cases, requiring the use of the knife and the cautery, might be diminished; and we may further add that, wherever either of these painful methods was still considered inevitable, every endeavour was made to abate the induced sufferings as much as possible, by every thing that professional dexterity and moral influence could suggest

"The art of Surgery thus acquired a character of prudence and security, which were not at all irreconcileable with boldness and decision; and the change thereby effected gave rise to a series of the most pleasing results, by which science, as well as humanity, have equally profited.

"How comes it that this period of improvement has had its epoch of retardation and arrest, and has been only of short continuance ?—Ask this question of the spirit of the age, so eager after novelties, so constant in its pursuit of the marvellous, and which has so often substituted fiction in the place of actual reality. There is a restless desire, in the present day, among all classes and estates of men, for brilliant and daring doings; and surgeons have not escaped the general contamination of striving to acquire distinction, without waiting for the sanction of time and experience.

"The first blow that was directed against Physiological Surgery, and which unquestionably has checked its progress in advance, was the division of the art into several sections, or special branches, such as Ophthalmology, Orthopædy, &c. &c.-a practice which now begins to be as much decried, as, a few years ago, it was extravagantly commended.

"It was thought necessary, as we have already said, that surgery, in order that it might not appear to follow either a merely routine or a retrograde course, should follow the experimenting spirit of the age, and join in the career of discovery and empiric research. At the time nothing seemed too difficult for it to accomplish. After having tried with a rare success the excision of the cervix uteri, our surgeons conceived the idea of extirpating the entire organ; after having laid open the abdominal cavity in order to find out the seat of a volvulus or internal strangulation, of the very existence of which the operator was not always sure, they sought to reduce into a precept of the art this most daring and dangerous undertaking, and also to institute a regular operation for the establishment of an artificial anus over the trajet of the Cæcum or ascending Colon.

"Experience had shewn that the section of the tendo Achillis served to remedy certain deformities of the foot; forthwith, the operation of tenotomy was applied to a vast number of tendons without any discrimination, and ere long we heard of surgeons performing it with the view of straightening ankylosed joints, and redressing incurvations of the spinal column!

"Cataract patients were tormented with a variety of operations, in the hope of some plan or other being discovered to extract or depress the crystalline lens a little better than Daviel, and a shade worse than Scarpa.

"The operation for harelip was the only restoration of the face that used to be practised; but, of recent years, attempts have been made to restore the nose and the eyes, the cheeks and the chin; and, without having much regard either to the amount of pain inflicted at the time or to the troublesome consequences that may follow, the surgeon now-a-days very generally acts with an equal boldness, and often too with nearly the same means, in attempting the cure of a simple deformity, as if the very life of his patient depended on the result of the operation. "Hunter proposed the application of the potential caustic for the cure of certain strictures of the urethra. In course of time, some practitioners sought to make of this method a general plan of treatment, and hence it came to pass that all cases without exception were treated either with caustic, or with incision and scarifications, and the more safe and rational method of dilatation was for a time almost entirely abandoned.

"The school of Dessault had much exaggerated the advantage of complicated machines for the general treatment of Fractures, and that of the present day seeks to replace every sort of bandage and splint by using moulds of plaster, in which the fractured limb is to be inclosed.

Really one can scarcely predict where the inventive spirit of our operators might stop, if this state of things were likely to last long without being checked. But fortunately for the interests of our science, these exaggerated notions and opinions, so little accordant with the genuine spirit of enlightened Surgery, are not shared by all. But the voice of reason and truth is for a time drowned in the eager clamour of the moment. Whenever any opposition or disbelief is intimated, we are at once silenced by the sacramental words, these are facts acquired to science. But may we not very fairly reply to this seemingly set-down argument, that the multiplicity of trephinings for injuries of the skull, the radical cure of herniæ by ligature, the operation for the removal of cataract by keratonyxis, the amputation of a limb to remedy the deformity of a projecting stump, the extirpation of goitre swellings, the excision of varicoceles, not to mention many other similar undertakings-were, each and all of them, considered at one time to be facts acquired to science; and yet where are these facts now? are they even so much as ever heard of?

"Having said so much in the way of censure, it might be fairly expected that we should now notice some of the acknowledged improvements and established discoveries, which have unquestionably been made in various departments of surgery since the beginning of the present century. But this we must reserve for another occasion. Enough, at present. As we have already said, it is not that our science has retrograded; it is only that our art has often exaggerated its importance, and unnecessarily multiplied the cases for its intervention."-L'Experience.

A NEW METHOD TO PROMOTE CICATRIZATION OF RECENT WOUNDS.

The plan recommended by M. Reveillé-Parise is not novel certainly; but he has managed to give it an air of originality, by the observations with which he accompanies its exposition. It is nothing more nor less than the careful Suction of recent wounds, either with the mouth or by means of an air-pump, as soon after

the infliction of the injury as possible. The reasoning of our author, as to the modus operandi of this rather antique practice, is ingenious and deserves notice.

“If all wounds," says he, " have a general tendency to suppurate, and if their immediate union is a phenomenon of so rare, as to be almost of exceptional, occurrence, the cause of this is very generally to be sought for in the presence of foreign matters in the wound, which must be discharged, somehow or other, before the process of cicatrisation can effectually take place. It is often very erroneously supposed that those foreign substances are always introduced from without, that they are on all occasions accessible to the senses, and that they may be removed with more or less difficulty, according to the peculiar circumstances of each case, by the hand of the surgeon. Now, so far from all this being the case, they often consist either of the effused or infiltrated blood, of an infinite number of minute coagula plugging up the divided vessels, or of the debris of the skin, cellular tissue, and lacerated or contused muscles, &c.-in very variable proportions, according to the nature of the wound, and the kind of instrument with with which it was inflicted. Contused wounds, as might be expected, exhibit the phenomena now mentioned in the most conspicuous and decided manner. But even in the case of incised and punctured wounds, we may assert that very generally the minute foreign substances, of which we have spoken, are present in greater or less quantity, and interfere more or less with the process of cicatrisation. These organic debris form a detritus, the elimination of which must often be effected by the process of suppuration, before the re-union of the wound can take place. To cleanse a traumatic surface is therefore a primary and most necessary indication, if we expect to induce its immediate cicatrisation, or even to abridge the time necessary for this process being effected. To effect this important object, no method is at once so simple and effectual as that of immediate Suction."-Bulletin de Therapeutique.

M. CAZENAVE ON THE TREATMENT OF PSORIASIS.

Of local applications, two of the very best are certainly the ointments of the Ioduret of Sulphur (one or two parts to 30 of lard), and of Pitch (one part to eight of lard.) M. Biett (the original proposer) and M. Cazenave have obtained most satisfactory results from the use of the former; but then let it be remembered that internal medication was diligently pursued at the same time. .There cannot however be a reasonable doubt, but that the Ioduret of Sulphur exerts a salutary modifying action on the dry and squamous state of the skin in such diseases as Lepra and Psoriasis.

M. Cazenave has, on more occasions than one, had an opportunity to observe that the application of the ointment by friction to one part only of the affected surface-for example, to one extremity-has been followed not only by a cure of the disease there, but also by a decided amendment of it in other parts of the body. The Pitch ointment should be applied to the scaly patches twice daily. The occasional use of an alkaline or of a vapour-bath will much promote the celerity, as well as the certainty, of a cure. The great objection to the use of the Pitch application is its smell and nastiness; bating these, it is certainly a most useful remedy. A variety of different sorts of Baths have been recommended in the treatment of squamous diseases; and certainly the practice of general ablution, in some form or another, will never be omitted by the judicious physician.

Á very simple and serviceable alkaline bath may be prepared by dissolving the common carbonate of Potash in the water-in the proportion of from four to eight parts of the salt to 500 parts of the fluid, or of from four to eight ounces to an ordinary tepid bath. The sulphur-baths may often be used in obstinate

cases with very decided advantage. Neither M. Biett nor M. Cazenave have ever witnessed any good effects from baths containing sublimate of mercury, as recommended of late years by several writers. But of all baths, according to their experience, the simple water- vapour bath is unquestionably the best. As a general remark, the use of this excellent remedy should never be neglected; and no other sort of bath need ever be had recourse to, until a fair trial has been made of the steam one.

As to internal remedies, the catalogue of those which, at different times, and by different writers, have been recommended, embraces a vast number of the substances in the Pharmacopoeia, besides many extrinsic and more homely formulæ. The most approved are unquestionably the preparations of sulphur, of antimony, and of arsenic, and the tincture of lytta. Sulphur, in various forms, is well adapted to young patients and persons whose skin is fair and also irritable, more especially when the disease is comparatively mild; but in inveterate cases of the disease it generally fails. M. Cazenave speaks highly of the Plummer pill as a most useful antimonial: sarsaparilla tea, to which a little mezereon has been added, may be taken with advantage at the same time. He has not often made use of the tincture of cantharides; although he acknowledges that, on many occasions, he has seen remarkable benefit derived from its administration, in the practice of M. Biett. But of all remedies, none are, in his estimation, equal to the preparations of arsenic. Under their use, the diseased patches, sooner or later, become warm, red, and often somewhat tumefied; at the same time the scales drop off from their surface, and they exhibit at first an erysipelatous appearance, which is subsequently replaced by a pale hue of the skin-a precursory symptom of the shrinking and progressive disappearance of the patches. In the Lepra Vulgaris the disks become partially broken up, their edges subside, the circles lose their rounded figure, and the debris of each ring proceed to resolution, often with a truly surprising rapidity. In our author's opinion, arsenic and the simultaneous use of vapour-baths, constitute the treatment of Psoriasis and Lepra: occasionally the application of some pommades, at the same time, may accelerate the cure.-Annales des Maladies de la Peau.

Remarks. A much safer, and often quite as efficacious, a remedy for Psoriasis as Arsenic, is the Liquor Potassæ, given in doses of from 15 to 30, or even 50 drops, thrice a day, in milk or beer. A weak solution of nitric acid in water will be found, in many cases, an excellent application to the scaly skin. As a matter of course, the use of baths should never, if possible, be omitted. If a regular bath cannot be procured, the free ablution of the entire surface with tepid water should be practised every night, before going to bed.-Rev.

STRYCHNINE A TEST FOR THE ADMINISTRATION OF MORPHIA
IN NEURALGIA.

Dr. Rougier, one of the physicians of the Hôtel Dieu at Lyons, published, last year, a work-entitled, "De la Morphine Administrée par la Methode Endermique dans quelques Affections Nerveuses, et de la Necessité de l'Usage interieur de la Strychnine pour achever le traitement et prevenir la recidive, &c."in which he has endeavoured to shew that the latter alkaloid may be used as a test to try the efficacy and permanence of the sedative effects of the former, in certain cases of painful disease. The Morphine is administered in the Endermic Method; and, for this purpose, Dr. R. prefers the use of the heated hammer (as recommended by M. Mayor of Geneva) for the purpose of vesicating the skin, to that of an ordinary blister, or of the pommade ammoniacale. From half a grain to five grains or even more of the morphine may be sprinkled on the raw No. LXXXI.