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the north and south experienced no shock, but only slight agitation in the waters of the sea, rivers, ponds, etc. It would also be an easy task to show, if space were afforded for the purpose, that the concussions which have been felt in this region, and even at the farthest extremities of the volcanic boundaries have an intimate connection with the volcanos of Etna and Vesuvius, inasmuch as for some time previous to an eruption of these mountains, earthquakes have generally been experienced along some portion of this particular line, and which have invariably ceased, as soon as the melted matter has found its way to the surface." 43.

Mr. Parkin remarks that when a shock has been experienced at a given spot, it is speedily propagated to another and distant point—“ always along some particular and well-defined line."

In the epidemic diseases under consideration a characteristic feature is progression along particular lines, whilst their effects extend but a short distance on the sides of these lines, like the volcanic shocks themselves. The line of cholera presented this peculiarity in a remarkable degree-attacking the inhabitants of one bank of a river, and sparing the other. It was the same with the "BLACK DEATH" of the 14th century. But we are unable to accompany our author through all the analogies between volcanic and epidemic phenomena. They evince great research after facts, and considerable ingenuity in harnessing these facts to the car of his theory. Thus, coincident with the "black death," a series of terrestrial commotions almost unexampled, occurred. An earthquake took place near Kingsai (where the disease first broke out) by which whole mountains were overturned, and a lake of more than a hundred leagues in circumference was formed. These concussions recurred for several years. The disease spread in a westernly direction across the continent of Asia to the shores of the Black Sea-to Constantinople-the cities of Europe-and ultimately to England-storms, floods, and earthquakes attending the route of this dreadful malady.

In respect to cholera, the Bengal Report states that, at first, the disease raged simultaneously in various and remote quarters:

"But soon after reaching the junction of the Jumma and the Ganges, the epidemic began to show one of the most striking peculiarities, which characterized its march. It no longer pushed its influence, without distinction or apparent choice, in all directions and throughout every tract coming in its way; but began to affect particular lines, and to fix itself in particular divisions of the country, wholly restricting itself for the time to the course of those lines and divisions." 128.

Although it branched off occasionally to right and left, still the grand march was westerly till it reached England-crossed the Atlantic, and visited America!

Earthquakes are very rare in India; but about the time of the breaking out of the cholera there were several shocks felt in Bengal, and for some years afterwards. Thus at Bhooj, in 1819, there were 15,000 houses reduced to ashes in two minutes. But we can go no farther. Mr. Parkin thinks he has proved, or rendered it probable, that "various gases are not only generated in subterranean reservoirs, but are also extricated in con siderable quantities into the surrounding atmosphere, and that to the direct action of some one or more of these products on the human frame we may possibly refer the production of epidemic diseases." Granting this-which

however, we think is not very clearly proved-we are still in ignorance of the nature of this gas-or of the cause of its producing cholera at one time-fever at another influenza at a third-and death, whether "black" or" blue," at all times. That the cause of cholera and other epidemic diseases is an emanation from the earth, and merely diffused in the air, we firmly believe, and have always maintained in this Journal. But that it is essentially connected with volcanic action, we are as yet far from being convinced, notwithstanding the ingenuity and industry brought to bear on the investigation by our author. A perusal of the work, however, will well repay the time expended, in consequence of the very curious information collected into a small volume from various and scattered sources.

I. ESSAIS SUR LA METHODE SOUS-CUTANEE. Par le Docteur Jules Guerin. Paris, 1841, pp. 126.

Essays upon the Subcutaneous Mode of Operating.

II. MEMOIRE SUR L'ETIOLOGIE GENERALE DES DEVIATIONS LATERALES DE L'EPINE. Par le Docteur Jules Guerin, 1840.

Essay upon the Etiology of Lateral Curvature of the Spine. III. RECHERCHES SUR LES LUXATIONS CONGENITALES. teur Jules Guerin. Paris, 1841.

Researches upon Congenital Dislocations.

Par le Doc

IV. MEMOIRE SUR L'INTERVENTION DE LA PRESSION ATMOSPHERIQUE DANS LE MECHANISME DES EXHALATIONS SEREUSES. Par le Docteur Jules Guerin. 1840.

A Memoir upon the Influence of Atmospheric Pressure in the Production of the Serous Exhalations.

V. MEMOIRE SUR UN CAS DE LUXATION TRAUMATIQUE DE LA SECONDE VERTEBRE CERVICALE, DATANT DE SEPT MOIs. Par le Docteur Jules Guerin. Paris, 1840.

Relation of a Case of Dislocation of the Second Cervical Vertebra of seven months' duration, successfully treated.

THESE pamphlets have appeared during the last two years in the pages of the French Medical Gazette, and have been noticed from time to time in the Periscope of this Journal; but their republication in a separate form, and the importance of the subjects to which they relate, demand at our hands a rather more detailed view of their contents than we have hitherto given. Three of the memoirs form part of a dissertation upon the defor

No. 87.

See Nos. 62, 64, 65, €6, 67.

10

mities of the osseous structure, which M. Guerin is now republishing, and to a portion of which we referred in our number for July last. The author is a bold and able surgeon, as apt with the pen in recording as with the bistoury in performing his various operations, and, certainly, if the results he declares he has obtained be confirmed by the experience of other practitioners, much of our surgical practice is destined to undergo considerable modification and extension.

1. THE SUBCUTANEOUS MODE OF OPERATING.

"It is," says Mr. Lawrence in his lectures, "the boast of modern surgery to have diminished the number of operations. I speak within limits when I assert that there are not so many operations performed now, by one half or two thirds, as when I first began to study the profession. This important difference to which I allude has arisen from the improved knowledge of the nature and treatment of disease." It would be well if some of those who have been seized with the prevalent mania for operating, would bear this observation in mind. It is indeed unquestionable, that many deformities have of late been discovered to depend upon perverted muscular action, and to be capable of relief by the division of the muscles or their tendons implicated, and that such division is not attended with the ill-consequences heretofore believed to result from meddling with these structures. But, when we observe the number of cases of clubfoot, strabismus, stammering, distortions of the spine, &c. which have latterly been submitted to the knife, we are tempted to believe that too little discrimination has been employed in the selection of cases likely to be benefitted, and, that a great deal of enthusiasm, and some charlatanism may have obscured the due consideration of the principles upon which operations should alone be undertaken. Upon what principles surgeons are enabled to boast their two or three hundred cures in the brief period of a year or two, we are at a loss to comprehend, at least if permanency is to be considered as one of the elements of a cure. If our predecessors in surgery performed more of the acknowledged operations than our improved knowledge allows us to undertake, they were at least far more careful in their institution of new ones; and before they recommended these for general adoption, examined all the circumstances connected with them with scrupulous care and exemplary patience. There can be no doubt, as we have already observed,that many of the deformities alluded to are relievable by the operations now in vogue; but, there can be as little doubt, that many which have been submitted to them never should have been so; and, that a most unwarrantable precipitancy in undertaking new cases, prior to a patient observance of the results of the first ones, has been committed.

However, if M. Guerin's observations upon "Subcutaneous Surgery" be correct, the multiplying of these operations is comparatively of no consequence, as the most formidable of them may be undertaken without any danger, and almost without inconvenience. He prefaces this republication of his views with an introductory chapter, in which he establishes his claims of being the first to prove that wounds, to which the access of the air is prevented, healed at once without any inflammatory or suppurative

process. It is true the harmlessness with which the subcutaneous section of the tendo-Achilles may be performed has been long known, but, even the most recent operators, as Dupuytren and Stromeyer, merely practised this as an empirical operation, believing that, by avoiding exposure, the suppuration or exfoliation of the tendon was prevented, but never referring this to any general theory or explanation. So, too, Dieffenbach attributed the success to the mildness of the inflammatory action, and never for an instant supposed that no inflammation whatever was present. M. Guerin first divided tendons in 1836, but did not permit the bistoury to pierce the skin a second time, viz. at the point where the incision terminated. Finding the one puncture sufficient, he was struck with the ease with which the wounds united, and the little trouble they caused; but so little did he himself at that time suspect the principle involved, that he, from dread of the operation, deferred for two years dividing the spinal muscles for those deformities dependent upon their contraction. The division of tendons by some other surgeons was not attended by the immediate union which followed his own operations, and serious consequences sometimes resulted. Upon reflection he discovered that these ill effects arose from the apertures of the skin being too large, and too directly over the incision of the tendon, and that the instruments employed were far too broad. Experiments upon animals, and subsequent experience, led him to draw the conclusion, that the absence of ill effects after division of tendinous structures, did not arise, as supposed, from the slight re-active power of the wounds of tendon, but from the exclusion of the air, an exclusion that produces what he terms "immediate organization," which is not only distinguished from but impeded by the presence of inflammatory action.

"What do my experiments upon animals and my operations upon man show? The former, made and repeated many times, comprehending subcutaneous incisions of all dimensions, from 1 to 30 centimetres, practised upon the limbs or trunk, single or multiplied, involving by turn tendon, muscles, nerve, vessels of small calibre, and even the bones themselves: these attended sometimes with effusions of blood, and performed under every possible combination, exhibited, at all times, an utter absence of suppurative inflammation, and the presence of 'immediate organization.' Sometimes, the incisions extended from the nape of the neck to the sacrum, traversing the muscles, vessels and nerves of the spine, the animal remaining as calm as if suffering from a mere scratch. Sometimes the wounds were far deeper and more severe, but never were they followed by suppuration. . . Is there a surgeon who would have dared, at the same sitting, to have performed upon one individual the subcutaneous section of more than forty muscles and tendons? That have I dared to do without hesitation or bravado, resting upon the truth of the principle laid down; and do not the boldness and novelty of my attempt, and the surprise and incredulity it excited, present us with some idea of the originality and certainty of this principle?

I may demand of the incredulous, to cite one solitary fact of suppuration ever having followed any of my subcutaneous operations; yet have these now amounted to more than two thousand, and I have performed publicly more than 500 since my election to the hospital for children.”

He reasonably objects to the want of success of those, who do not adhere rigorously to his method, being laid at his door. The work itself

* A centimetre is inch 0.394.

consists of two Essays; the first relating to subcutaneous wounds in general, and the second to those of the joints in particular. An Appendix contains a few cases recently treated by some other surgeons.

1. On Subcutaneous Wounds.

A. Experimental Part.-In this the author relates the various experiments he made upon dogs prior to trying the operations upon the human subject, and the results of these latter. A detail is unnecessary; suffice it to say, some of the most important muscles of the body were among those divided, and that the incisions frequently extended from 8 to 10 centimetres in length, and from 4 to 5, or on some occasions even to 10 or 12, centimetres in depth. A considerable effusion of blood beneath the skin and between the lips of the wound at once occurred, but a small piece of adhesive plaster, and the employment of slight pressure, were the only means had recourse to. No local inflammation or general fever ever resulted. The patients after the third day were enabled to arise, and when supported to walk, and to employ the various mechanical means necessary to complete the removal of the deformity.

B. The Theory of the Immediate Organization of Subcutaneous Wounds. What theory the author may have in his mind we know not; but, all he expresses is the simple fact, that the exclusion of the air permits, and its admission prevents wounds undergoing the process of immediate organization, as he terms it, though, in what this mode of healing differs from that of union by the first intention, we are at a loss to perceive.

c. General Consequences and Applications.-M. Guerin observes, that all wounds, however they may differ in their early stages, according as they present the adhesive or suppurative forms of inflammation, resemble each other in their latter stage, that of cicatrization. Cicatrization takes place speedily in proportion as the air is excluded, and even in suppurating wounds this process only occurs after such exclusion; in these this is effected by means of the membrane, first described by Bichat as existing upon suppurating wounds, and afterwards denominated the puogenic membrane-the formation of pus not being, however, a special secretion, requiring any special organ, but a mere modification of the blood, transuding through this membrane into contact with the air.

The practical applications of the doctrines brought forward in this essay are indeed important. In the treatment of wounds, the importance of bringing all the parts into accurate contact, and of effectually closing their orifices, is at once seen. Wounds of the great cavities of the body, for example, should always be treated upon the principle of obtaining immediate union. Experience alone will demonstrate all the various cases in which the subcutaneous mode of operation may be employed, but many may even now be indicated. Thus, a vast number of operations upon tendons are performed with success, which formerly never could have been attempted; congestive abscesses forming in the groin, thigh, or lumbar region, have been opened in several individuals suffering from tubercular affections; the sphincter has been thus successfully divided for fissure of the anus; various serous and sanguineous subcutaneous effusions have

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