so worthless, as to warrant the repetition of this operation, again and again, till, forsooth, we thus obtain more extended statistics? Mr. Key compares the condition of a patient labouring under ovarian dropsy with that of one suffering from stone, and suggests that the arguments for lithotomy in the one are analogous to those which justify ovariotomy in the other. We cannot admit the exactness of this analogy, seeing that in many cases of ovarian disease life is not very materially shortened, and, in a still larger proportion, is not rendered by any means intolerable; while the reverse of both these conditions notoriously exists in the calculous cases usually submitted to operation. But, if the analogy be granted, does it follow, because we practise an operation which is fatal to 1 in 7 of those who submit to it, in order to relieve a patient from the stone, that we are therefore justified in performing an operation fatal to 1 in 3, in order to remove a diseased ovary? Besides, in lithotomy it is a thing almost unheard of, for the operation to be performed and no stone to be found in the bladder, or for its extraction to be impracticable; but in nearly 1 in 4 of the instances in which ovariotomy has been attempted, an analogous result has occurred. The difficulties attending the performance of lithotomy are so serious as to deter self-sufficient ignorance from attempting it; but, as Mr. Key says, in words very similar to our own, in the October number of this Review, and which stirred the bile of more than one of the doughty champions of ovariotomy: "The operation is of so simple a kind, requiring so little knowledge of anatomy, and so little skilful surgical manipulation, compared with what the other larger operations in surgery call for, that I need not dwell minutely on the steps of its performance;" or, as we should say, that there is imminent hazard of many women being destroyed, and the fair fame of the profession tarnished, by the recklessness of some whose heads are turned by a little notoriety, or even by the hope of attaining it; and who begin incontinently to dream of themselves as Hunters, Harveys, and Hallers.

Let us not be misunderstood: far be it from us to censure indiscriminately. We know that such men as Messrs. Key, Cooper, Lane, &c., can be influenced by no unworthy motives in performing such an operation; and we believe the best men may not only be justified but almost forced to perform this one, under peculiar circumstances. In reference to his own case, Mr. Key, after weighing the reasons for and against its performance, says: "Nevertheless, I thought it my duty to perform the operation;-a duty which every surgeon must occasionally feel to be a painful part of his profession, but from which a lower feeling must not induce him to shrink." Unfortunately, however, all have not treated this subject in the modest, self-forgetting, truth-loving spirit which becomes members of our noble profession.

We have endeavoured to show the results which have hitherto attended this operation, and have always stated the truth and the whole truth as nearly as we could arrive at it. We think that the often-repeated performance of this operation, while comparatively so little has been done towards facilitating our diagnosis of ovarian and uterine tumours, and while at the commencement of the operation it is a matter so very uncertain

This estimate of the amount of mortality from lithotomy rather overstates than understates the fatality of the operation, as will be seen by reference to the very elaborate and valuable tables in Chapter 11 of Dr. Willis's work, On the Treatment of Stone in the Bladder.'

whether its completion will be practicable, is mere crass empiricism, wholly unworthy of the medical art. Each day, too, brings some fresh confirmation of our opinion; and in the Medical Gazette, for Dec. 9, 1843, the reader will find the particulars of a case that would justify language far stronger than we have ever used. A woman in ill health, and suffering from profuse periodical discharge from the uterus, was received into the Manchester Union hospital for the cure of an abdominal tumour. Mr. Heath and his colleagues, after repeated and careful examination, decided that the tumour was ovarian, and considered that the patient presented "a fair case for extirpation by the abdominal section." The abdomen was laid open by an incision, reaching from the ensiform cartilage to within an inch and a half of the symphysis pubis, when it was discovered that the uterus and not the ovary was the organ diseased. Mr. Heath, however, proceeded to remove it, and actually extirpated the entire uterus, except the cervix and about two inches of the body! The mass altogether weighed six pounds. The patient survived 17 hours after the performance of the operation. Respect for the manly honesty which Mr. Heath has shown in the early publication of this case, induces us to abstain from commenting on it; but indeed it comments on itself. We will only add, that we doubt much whether Mr. Heath would have ever had the hardihood to attempt the operation, still less would he have ventured to complete it as he did, if he had not been misled by the exaggerated and incorrect accounts that have been laid before the profession of the results of extirpation of the ovaria. And here we feel it our duty to animadvert, in the strongest terms, on the backwardness of those who, having so speedily published their successful cases, delay to publish their unsuccessful ones. We are unwilling to impute improper motives to these gentlemen; they may have good reasons for their silence of which we are ignorant; but the reasons must be strong indeed to justify a proceeding fraught with such momentous consequences to the profession, and to society at large.

We think, then, that a much more attentive investigation of ovarian disease and its treatment than has ever yet been made, is necessary, before we shall be able to predicate of certain cases that they are incurable by other means, that this operation affords a reasonable prospect of their cure, and that no modification of it will attain the same end. Till we can do this with tolerable certainty, the operation appears to us to be an unwarrantable proceeding. This opinion of ours may be wrong; we hold it simply because we have been led to it by a careful study of the subject, and will gladly retract it so soon as we find that we have been mistaken. In the meanwhile we would remind some gentlemen who seem to have forgotten it, that it is quite possible to arrive at conclusions different from their own, without the decision having been biassed by prejudice, or prompted by party-feeling. There is such a thing, sceptical though some may be with regard to its existence, as a sincere love of truth for its own sake; and we venture to express the belief that it always has been and always will be the characteristic of this Review.*

• Since this article was printed, the account of a second successful case by Dr. F. Bird has been published. The operation was of the intermediate kind, the length of the incision being rather less than six inches. At the date of the last report, (17th day from the operation,) the patient was convalescent. See 'Medical Times,' December 16.

PART SECOND.

Bibliographical Notices.

ART. I.-Animal Physiology. (From the Popular Cyclopædia of Natural Science.) By W. B. CARPENTER, M.D. &c.—London, 1843. 8vo, pp. 580.

We

THIS work, which forms part of the Popular Cyclopædia of Natural Science,' like all the writings of the author, affords a clear exposition of the subject of which it treats, and is well calculated to render the general reader familiar with some of the most abstruse, but most important, subjects of physiology. It is written in a familiar and exceedingly clear style, and is, we think, calculated to convey most valuable information not only to the general reader but also to the medical student. The plan of combining natural history with physiology is the only way in which this latter subject can ever be made popular. To illustrate abstruse questions by the familiar example of some interesting and constantly occurring facts in natural history, not only tends to lighten scientific details, but puts the facts themselves in a new position, and gives additional force to them. This has been managed by Dr. Carpenter in the present volume in a very admirable and pleasing manner. may point to some of the chapters in proof of our remark. Take for instance the chapter on the Circulatory System. The whole of this subject is well worked-out up to the period when this part of the Cyclopædia' was published. We do not hesitate to affirm that while this will afford a vast deal of information to the general reader, it will convey much new information not merely to medical students but to medical practitioners generally. So again, in regard to the Functions of the Nervous System. This chapter gives a more precise and definite notion of the functions of this part of the body than any book we have yet met with. Again, the chapter on Reproduction and Development will convey an excellent idea of these great functions, without obliging the reader to wade through details that would often tend to fatigue, and perhaps to create some displeasure with the subject in the minds of non-professional readers, for whom these volumes have been expressly written. But, in truth, the whole work is of that genuine masterly stamp which characterizes all the productions of this writer, even those, such as we believe this to be, which are the fruits of his leisure hours, and are not intended for the learned. It is certainly without parallel among the treatises on subjects of natural science hitherto presented to the public, and may be confidently recommended to readers of every class, as fraught with important information not elsewhere to be found in so agreeable a form.

XXXIII-XVII.

16

ART. II.-Some Observations on the Mental State of the Blind and Deaf and Dumb; suggested by the case of Jane Sullivan, both blind, deaf, dumb, and uneducated. By R. FOWLER, M.D. F.R.S.-Salisbury, 1843. 12mo, pp. 64.

THIS little pamphlet is well worth the perusal of those who feel an interest in the remarkable class of cases of which it treats; and as the public mind has been lately much directed towards the American girl, Laura Bridgeman, whose remarkable progress has been due to the untiring exertions and intelligent guidance of Dr. Howe, the notices collected by Dr. Fowler, of several cases presenting the same deficiency, but in which no attempt at education had been made, are additionally valuable, for the sake of comparison. He considers that, from observations made upon such cases, important inferences may be drawn, in regard to the muscular sense, to which he attributes that preparation or adjustment of the organs of special sense for the ready reception of impressions, which takes place when the attention is directed to the sensations they convey.

ART. III.-General Therapeutics and Materia Medica, adapted for a Medical Text-book. By ROBLEY DUNG LISON, M.D., Professor of Institutes of Medicine in Jefferson Medical College, Philadelphia, &c. -Philadelphia, 1843. Two Vols. 8vo, pp. 988.

THE works of Dr. Dunglison are of a very uniform character. They are those of a well-informed, industrious, and judicious professor of medicine, who aptly perceives the kind of books that are wanted within the sphere of his own activity, and who is well qualified to supply the desiderata. We by no means intend to insinuate, however, that Dr. Dunglison's works are not calculated to be everywhere useful. The volumes before us consist of a republication of the author's work on 'General Therapeutics,' with a new treatise on Materia Medica.' Only seven years having elapsed since the first appearance of the former, little addition or alteration has been required; for changes in our views of general therapeutics come round but slowly, while every month brings forth some novelty in the specialities of the healing art. The subject of materia medica has been handled by our author with more than usual judgment. The greater part of treatises on that subject are, in effect, expositions of the natural and chemical history of the substances used in medicine, with very brief notices of their medicinal virtues, and scarcely any notice at all of the relations which obtain between the special indications they are capable of fulfilling, and the general principles of therapeutics. In short, such books are adapted merely for the apothecary. Dr. Dunglison, very wisely in our opinion, has reversed all this, and given his principal attention to the articles of the materia medica as medicines. Nevertheless he has, in all instances, "referred to the position held by the drug as an article of the organized or of the inorganic kingdom, as well as to general matters of interest relative to the place where it is found; the manner in which it is obtained; and to certain points connected with its commercial history; but next to therapeutical applications, he has dwelt more at length on the sensible properties by which the physician may be enabled to judge of the various articles from his own observation." (Preface.)

Dr. Dunglison has succeeded very happily in connecting general with special therapeutics. His work is cast in a somewhat similar mould with that of Dr. A. T. Thomson on the same subjects. If the latter have, perhaps, the advantage in plenitude of materials, the former is more lucid in its arrangement and simpler in its expositions; but as the materia medica of the one is conformed to the British Pharmacopoeias, and of the other to that of the United States, there is ample room for them both. Dr. Dunglison has modified the classification of therapeutical agents, adopted in his General Therapeutics,' when first published. It now stands as follows:

Emetics.

1. Agents that affect prominently the alimentary canal or its contents Cathartics. 2. Agents that affect prominently the respiratory organs

3. Agents that affect prominently the follicular or glandular organs

Anthelmintics.
Expectorants.
[Errhines.
Sialogogues.
Diuretics.
Antilithics.
Diaphoretics.

Narcotics.
Tetanics.
Antispasmodics.

Parturients. Excitants. Tonics. Astringents. Sedatives. Refrigerants. Revellents.

Eutrophics.

Antacids.
Antalkalies.
Disinfectants.

S Demulcents.

We do not attach much importance to arrangements of this nature, which, in the present state of our knowledge, cannot even approximate to accuracy. All successful attempts at classification must be based on the recognition of certain distinctive and invariable characters in the objects classified: how little this is the case with respect to therapeutic agents, it would be superfluous to demonstrate. Dr. Dunglison has here introduced two new terms. To one of these we decidedly object, namely, parturients, the use of which would imply that the therapeutic agents themselves were about to bring forth infant remedies. It would not be easy to find an appropriate name for such agents, for the Greek language, as far as we know, contains no verb signifying "to cause to bring forth," nor does it afford any combination which would aptly designate the agents in question, unless, indeed, it be tocogogues, from TOKOS partus, and ayw duco; we believe, after all, that worse terms have passed current. The other term to which we allude is eutrophics, (promoters of healthy nutrition,) which Dr. Dunglison has substituted, judiciously we think, for "alteratives," a term conveying no distinct meaning.

In conclusion, we strongly recommend these volumes to our readers. No medical student, on either side of the Atlantic, ought to be without them.