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Bell on the Nervous System.

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much confidence in his statements, among those of his professional brethren whose good opinion is most worth having. The practice of authors publishing patients' eulogistic and recommendatory letters cannot be too much censured. It always savours of the advertising school, to which too many of the medical authors in the present day give countenance by their own practice.

ON SIR CHARLES BELL'S RESEARCHES IN THE NERVOUS SYSTEM. By Alexander Shaw, Surgeon to the Middlesex Hospital. 4to. pp. 40. Murray London, 1847.

THIS Essay is appended to the posthumous edition of the well known "Anatomy and Philosophy of Expression, as connected with the Fine Arts." It contains a remarkably lucid exposition of Sir C. Bell's discoveries, written in a pleasing and very graceful style, and illustrated with many interesting facts drawn from the field of Comparative Anatomy. We must find room for one extract:

"Man is distinguished above all other animals by his lower extremities having solidity and power sufficient to sustain his body without the aid of other members, and so as to be his sole organs of progression: hence his erect position. Again, as man's upper extremities are emancipated from the duty of assisting in locomotion, they are free to execute whatever rapid and varied movements may be called for, either for self-defence or for procuring nourishment. And, in correspondence with that freedom of action, a Hand is added, which, for the perfection of its endowments and mechanism, has been, in all ages, a constant theme of admiration.

"Now let us ask, what influence have the improvements thus shown in the construction of the organs of locomotion and of prehension, upon the structure of the Mouth? The chief use of the prehensile organs being to seize food for the supply of the mouth, it may be expected that, as they become more highly organized, the mouth will undergo a change in its form. What, then, is the effect of the improved organization of the prehensile organ, as seen in the hand of man, in allowing the mouth to be adapted for a vocal organ-an organ of Articulate Language?

"It has been stated that in all the vertebrate animals below man, the member analogous to the arm and hand, is an instrument of progression as well as of prehension. Whether we take the fin of the fish, the anterior extremity of the reptile, the wing of the bird, the paddle of the dolphin, or the fore leg of the horse or dog, the principal, if not the only use of the member is to assist in locomotion; only a few quadrupeds, like the squirrel, the feline animals, &c., besides using their paws for running, climbing, burrowing, &c., employ them to carry food to the mouth. Now the consequence of using the organ intended to convey the food to the mouth as one for progression, will be, that the office of appropriating the food will be thrown upon the mouth itself. Accordingly, in all animals below Man, the mouth is a prehensile, as well as a manducatory organ. If the animal be graminivorous, it must crop the herbage with its teeth before chewing and triturating it; if it be carnivorous, it must be provided with large, sharp fangs or tusks, to fight, seize, and tear its prey, before it can reduce. its food to a fit state for swallowing. In short, the mouth, with its delicate sense of touch, its hairs or whiskers projecting from it as feelers, and its jaws armed with large teeth, is to be looked upon, in conjunction with the long, flexible neck commonly belonging to brutes, as combining the functions of the human arm and hand, with that of an organ of mastication.

"But it is obvious that a mouth of the large capacity and irregular shape of an animal like the horse, ox, dog, or lion, could never be adapted to produce articulate sounds. In a cavity such as the mouth of the horse, we can under

stand how neighing may be produced; but we cannot suppose that, by any adjustment of the tongue or lips, the air, even if it were properly vocalized in the larynx, could be confined, and then be let suddenly free to give rise to explosive sounds; or be impinged against the palate, to cause guttural sounds; or be directed into the back of the nostrils, to produce nasal sounds. In short, none of those numerous, finely-varied changes in the shape of the interior of the mouth, produced by the combined action of the tongue, palate, cheeks, and lips, which give rise to the infinite modifications of sound in speech, could take place in such gross structures. For the vibrating air expelled from the larynx to be divided and modulated so as to produce words with proper tone and accent, it is necessary that the cavity of the mouth should be small, its boundaries regular and uninterrupted, and the communication between it and the nostrils, free. "Now that is the very character of the mouth in Man." P. 35.

MEDICAL STATISTICS, THEIR FORCE AND FALLACY. By James Duncan, A.M.,M.D. 8vo. p. 42. Dublin, 1847.

INTRODUCTORY lectures are proverbial for their dullness, their repetitions, and the inordinate quantity of inanities they are the privileged medium for the communication of. Dr. Duncan has thought proper to break through the ordinary routine, and the consequence is the production of a very interesting exposition of some of the deductions derivable from the examinatian of the RegistrarGeneral's and the British Army Reports, and of some of the errors to which an undue reliance upon figures may give rise to.

Dr. Duncan first adverts to the different degrees in which the two sexes are affected by disease. It is well known that a larger portion of males are born. The English (1838-41) Registrar and Irish Census (10 years) Returns, give 2,240,938 male for 2,142,272 female births, and yet at any period the actual number of the sexes living is reversed. The general population of Great Britain and Ireland in 1841 was 13,097,012 males and 13,742,873 females. This result can only occur from the the excess of mortality in males, and the Reports above referred to register 1,318,853 male to 1,241,207 female deaths. Moreover, the difference does not occur at the advanced periods of life when the different habits of life might to some extent explain it, but in infancy, when every influencing condition of the sexes seems similar; so that for 406,684 male deaths under two years, there were but 344,935 females. After this period the sexes remain very similarly circumstanced until the period of puberty, when the difference is found to be in favour of the males until the 40th year. To about the 45th the deaths are nearly equal, after which until about 60, the males again form the excess-females constituting the majority of those who die in advanced years. Dr. Duncan draws attention also to the relative frequency of consumption in men and women. Authors have been divided upon this point: but the Registrar's Report for 1838-40 gives us 90,611 deaths in a female population of 7,885,615, and 80,550 deaths in a male population of 7,668,245; but it is a curious fact, that while consumption is more frequent among females in the general and rural population, it is more frequent among males in cities and large towns; for while in 100,000 of the general population there would be but 378 male and 408 female deaths, in that of London there would be 451 males to 377 females, and in Birmingham 526 males to 410 females.

We cannot follow the author in his examination of the proportion of deaths caused by consumption in our military service in different parts of the world, important as information derived from such considerations is in confirming or correcting the prevalent ideas upon the effects of climate in this dreadful disease; and we must content ourselves by very briefly adverting to some of his observations upon the abuse of figures. For example, the superiority of any given in

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Gream on the Diet of Children.

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stitution in the number of cures it produces should never be affirmed until the rules governing the admission, diet, &c., of patients are understood. The ratio of mortality without this may be apparently, but not really, much greater in a given disease in a workhouse than in a hospital, or in two institutions ostensibly similar. The author agrees with those who regard the numerical method as incompetent to aid in the treatment of disease.

"A number of cases of a disease, say delirium tremens, are treated in a particular way, and the result is compared with an equal number of cases treated differently, and a conclusion is drawn in favour of the plan which appears to secure the largest number of recoveries out of the entire. To this theory as thus explained there are many objections. Let us suppose, however, that the trial has been made to what practical result, I ask, can it possibly lead? Are we to understand that, having found out a certain plan to be successful in a large majority of cases of any disease, that it is to be applied, with unbending exactness, to every other example of it we may meet with? Is there to be no regard to the stage of the disease, the constitution of the patient, the character of the prevailing epidemic? If there is, of what value is the supposed statistical announcement, to guide us in the varying circumstances in which we may be placed? If such distinctions are disregarded, in what is our conduct less absurd than that of the mere pretender to physic, who, with a boldness only unequalled by the credulity of the public, invents his specific, and declares that it is a panacea for all diseases-that it is suited to all constitutions, and that, while it will infallibly cure, it will do no harm.”

REMARKS ON THE DIET OF CHILDREN; AND ON THE DISTINCTIONS BETWEEN THE DIGESTIVE POWERS OF THE INFANT AND THE ADULT. By George T. Gream, one of the principal Medical Officers of the Queen Charlotte's Lying-in Hospital, &c. &c. Small Svo, pp. 201. London: Longman and Co., 1847.

We should have been quite at a loss to know why Mr. Gream should have published this book, if he had not been so obliging as, in the concluding paragraph of it, to assign his reasons for doing so.

"In bringing to a conclusion," he says, "these practical remarks, which have been almost extorted from me by the sufferings to which numbers of children are exposed, as I daily witness, through the ignorance or thoughtlessness of their attendants, I venture to express a hope that they may not only prove useful, in the domestic circle, among parents, and others who have the charge of infancy and youth, but that they may, as tending in however humble a degree, to advance and enforce their own views and principles, obtain a favourable reception from those of my own profession, to whom we are indebted for the establishment, on scientific grounds, of those practical and judicious regulations for the management of children, which are now more or less adopted by the most eminent and successful practitioners." P. 201.

We fear, from the loose, superficial, and common-place character of Mr. Gream's observations, that his most alluring motive was the not very disinterested one of being useful in the domestic circle, among parents, and others who have the charge of youth. We think it just possible that, in this respect, the book may answer the purpose; because the persons to whom it is addressed are not the most discriminating critics of a medical author's merits, and Mr. Gream has several very comforting precedents of similar popular books having puffed their authors into practice. After these remarks we need scarcely say that, to welleducated medical men, or even to pupils, Mr. Gream's book is not likely to be of use; and that it is more likely to be a vade-mecum for Mr. Gream himself, than to have any more extensive application.

Periscope;

OR,

CIRCUMSPECTIVE REVIEW.

Selections from the Foreign Periodicals.

ON LETTING BLOOD FROM THE JUGULAR IN THE DISEASES OF CHILDREN. By C. HILDRETH, M.D. Zansville, Ohio.

DR. HILDRETH, after observing that leeches, which are usually recommended in the acute affections of infancy, are sometimes not obtainable without great difficulty, goes on to state his opinion, that general bleeding in many of these is far preferable, and that the jugular vein is the one best adapted for the purpose at this period of life. "I would make this operation the rule instead of the exception in many of the acute affections of children under two or three years of age; and also in older subjects, in certain diseases of the brain and trachea. As the head in infancy is larger in proportion to the size of the body than in the adult, so also is the cerebral vascular system more developed, and hence we find the jugulars relatively larger and more prominent in the first years of life." The veins of the arm at this early age are found with great difficulty, and a sufficiency of blood hard to be obtained from them, while the near proximity of an artery has prevented practitioners opening a vein in cases where the loss of blood was urgently called for.

Dr. Hildreth considers the fear of air entering the vein as quite visionary, providing the operation bas been properly performed; and believes this mode of abstracting blood as especially efficacious in inflammation of the larynx and trachea, cerebral inflammations, and congestion causing convulsions. “We also much prefer letting blood from the jugular in the acute inflammations of the thoracic viscera. One of its chief advantages is the great rapidity with which blood flows from a free orifice in the vein. A decided impression can thus be made upon the system in a very few moments, and with much less loss of blood than would be required to produce the same effect from a vein in the arm, or by the still slower process of leeching or cupping."

arms.

66

The following are Dr. H's directions for performing the operation in a more simplified manner than is usually recommended. It is essentially necessary in letting blood from the jugular of a refractory child, that the head and chest should be immovably fixed, otherwise the flow of blood will be interrupted or stopped entirely. The nurse having exposed the right shoulder of the child, seats herself upon a low chair, and in holding the child across her knees carefully confines its The surgeon, seated at her side, receives and secures the child's head between his knees. With the thumb of the left hand, he now compresses the jugular across where it crosses the first rib, while the remaining portion of the same hand is emloyed in fixing the chest of the child against the person of the nurse. The right hand of the operator being at liberty, he makes the opening into the vein. The blood is received in a cup, the edge of which applied a little below the orifice, likewise serves to compress the vein. From a robust child blood escapes with astonishing rapidity, particularly when he cries or struggles. No effort, therefore, should be made to keep him quiet, his cries being rather encouraged as they expedite very much the operation. A sufficient quantity of blood is very soon lost, the colour of the lips and cheek of the child telling when syncope approaches much more certainly than

1847] On Bleeding Children from the Jugular Vein.

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the pulse. The quantity of blood desired having been lost, a compress is applied to the orifice, and the pressure taken off from the vein below. After the child becomes quiet, the compress is removed, and the wound closed by a piece of court or adhesive plaster. This is much the best dressing, the compress and bandage usually advised being very objectionable. It not only obstructs the free return of blood from the head, but its presence irritates the patient, and if not well adjusted may promote the flow of blood or interfere with respiration. If, however, all pressure be removed from the vein below, blood will not escape if no dressing be applied, except the child cry or struggle. We therefore much prefer, if the proper dressing be not convenient, leaving the orifice uncovered, and directing the nurse to apply the compress for a moment, should blood escape during the cries of the child."

However young the child may be, Dr. Hildreth feels convinced that, in the above-named inflammatory diseases (he prefers leeches in inflammations of mucous membranes in general and of the abdominal viscera in particular) accompanied with high fever, a smaller quantity of blood so abstracted will suffice than if it had been taken in the ordinary manner-and in young children the jugular is the only vein of sufficient size to admit of the certain and safe abstraction of blood. He relates a few cases in proof of the prompt benefit occurring from the operation."-American Journal Med. Sciences, No. 26, pp. 369, 74.

[We feel great pleasure in giving an abstract of the above paper, as we feel convinced it draws attention to an important practical fact. We are no advocates for depletion of children to the extent sometimes recommended; but in cases wherein the prompt loss of a certain amount of blood seems indicated, we agree with Dr. Hildreth, that it may oftentimes be more advantageously abstracted by jugularotomy than by leeches. We shall not soon forget the instant and marked relief we once saw thus produced in a case of croup.-Rev.]

OBSERVATIONS INTRODUCTORY TO A COURSE OF CLINICAL SURGERY. By M. MALGAIGNE.

From the time of Celsus certain physical qualities have been expected of the surgeon, namely, that he should be young, adroit, and ambi-dextrous. M. Mayor of Lausanne would send him to study among the carpenters and joiners; in a word, his has been looked upon as a mere mechanical art, quod in therapeiá mecanicum, according to the expression of Richerand. But is this the only employment of the surgeon? Is it as in the middle ages, when the physician sent for him to perform certain mechanical operations and then dismissed him? No! After having been so long a subaltern, the surgeon must now take that rank which is his due. The physician may be ignorant of surgery, but the surgeon should know medicine; for in how many instances are surgical affections preceded or followed by phenomena which involve the entire economy! That he should be adroit can but be of great utility to him; but as to being ambi-dexter, few persons can boast of this, and frequently those who can, as Rivarol observes, have only two left hands.

For our parts, what we demand of the surgeon before all things is, that he have a healthy, cultivated, and philosophical mind, and a high moral character, and that he should not be, as Celsus would have him, without pity. Surgical morality is of especial importance in respect to new operations-experiments to be tried on the living man. We must think more than once when human life is at issue. He should possess a philosophic spirit, in order that he may verify before he believes, not accepting the dictums of his teacher without examination. Faith in authority at the present day must yield to faith in facts. His mind should