that in every case the effusion does not take place, but in the latter stages of the disease.

The action which takes place in hydrocephalus, is shown to be very different from the inflammation of phrenitis; the opinion of Dr. Quin seems to approach nearer the truth; but it is observed by Dr. Cheyne, that there is some change prior to the morbid accumulation of blood, "there must be an active before there is a passive state." He is inclined to think that the morbid action in the brain is specific; that excitement first takes place, then increased vascular action, congestion, and effusion.

"That in this disease there is produced a venous congestion, in addition to, and probably arising from the increased arterial action: that the effusion of serous fluid arises from this venous congestion: that this effusion has a tendency to counteract the baleful effects of the increased action, and to retard the fatal termination of the disease; of course, that the effusion into the ventricles is not the cause of the violent symptoms; and that the increased arterial action, though perhaps varied, does not cease when the congestion and effusion have taken place."

The stage of torpor he supposes to commence with the congestion of the venous system. Effusion is not considered as the cause of death, because large effusions of serous fluid have long subsisted with the continuance of life, as in chronic hydrocephalus.

"It is the morbid action of the bloodvessels wasting the brain, and unfitting it for its functions, which destroys the child; and I think it no rash opinion that death would occur earlier in the disease, did not the fluid exude, and thus continue to the brain the necessary degree of support from within, which would have been lost by the wasting of the organ.".

This, however, we are disposed to consider merely as a bold and ingenious hypothesis. The author has at least shown, that the presence of water in the ventricles is not necessarily fatal to life; though in some of the instances it should be remarked, that the pressure from the fluid may have been obviated by the separation of the bones, and enlargement of the head, as in chronic hydrocephalus; and in other instances it is impossible to say how long the water had been effused before the cessation

of life, or if in some it had not been the immediate cause of death. The stage of excitement and increased sensibility, has been attributed by Dr. Cheyne to the increased vascular action; the stage of torpor to the congestion in the veins; and is it not highly probable, that the paralytic and convulsive stage, which ushers in the death of the patient, marks the effusion into the ventricles?

Having recapitulated the pathological facts unconnected with hypothesis, and observed that we are at present ignorant of any way of subduing hydrocephalus, without the substitution of another constitutional irritation, Dr. Cheyne proceeds to the treatment of the disease. The indications of cure laid down by him are,

-"To remove from the constitution every irritation which either may have given rise to, or may have assisted, by morbid sympathy, in prolonging the diseased action in the brain;—to subdue the hydrocephalic action, 1st, by diminishing the increased activity of the circulation within the head; 2dly, by substituting a new action;-to alleviate pain and sickness, if ever urgent; to accept every assistance offered by counter-irritation; to support and renew the strength; to support it more particularly under any critical discharge."

The connexion which is shown to subsist between irritation in the alimentary canal, and the hydrocephalic excitement, claims, according to this view, a very early attention. Strong cathartic medicines are often required, and in most cases the very best effects may be expected from a course of purgatives.

The practice of Dr. Hamilton, and the great success which has attended the use of purgatives, are already known to the public. The experience of our author confirms the utility of this treatment. His plan is, when called early, to recommend -"the exhihition of the largest dose which can be safely prescribed, of some powerfully cathartic medicine, two, three, or four times a-day; and this continued for several days, or until natural stools are procured. The advantage of keeping the intestinal canal under the continued influence of a stimulus, I have, in various instances, found to be so great, that I am induced to repeat the declaration of my belief, that the happiest result may be expected from this measure." 2 D

VOL. I.

The increased activity of the circulation within the head, is to be diminished by local or general bloodletting, according to the circumstances of the case; and the abstraction of blood, it is remarked, is useful on another account, to render the constitution susceptible of the powers of mercury.

From blisters he has frequently observed a remarkable mitigation of the symptoms. However, so soon as the existence of the disease becomes probable, no more time should be lost than is necessary for subduing the disorder in the bowels; we must then commence the mercurial course, which, it must be allowed, has cured hydrocephalus even when far advanced. The object of the mercurial course, is to substitute a new action or counter-irritation, by which the hydrocephalic action shall be suspended or subdued: examples of which have come under our author's observation, and under that of other physicians. Digitalis is a remedy of considerable promise in this disease, from the command which it has over the circulating and absorbent systems. The author's experience of this medicine in hydrocephalus, has not been great; but he has observed it to produce a great, and in two cases he conceives a salutary, influence.

A valuable collection of cases is annexed to this essay. From these cases the results and doctrines of the text have been drawn. They are of themselves important and instructive. "They were invariably drawn up in the bed-chamber of the patient, and present a faithful account of every symptom and circumstance that attended the disease."

Practical Observations in Surgery, illustrated by Cases. The second Edition, corrected and enlarged; with additional plates.

BY WILLIAM HEY, F. R. S.

Member of the Royal College of Surgeons in London; Honorary Member of the Royal Medical Society of Edinburgh, and of the Literary and Philoso phical Society of Manchester; and Senior Surgeon of the General Infirmary of Leeds. 8vo. pp. 578. Price 13s. London. Cadell and Davies. 1810.

From the London Medical Review for 1810.

THIS is a new and much enlarged edition of one of the most valuable contributions that has ever been made to surgery. So much knowledge without pretension, improved by observation so well conducted and matured, are equally calculated to arrest the public confidence and to maintain it by just decisions.

With exemplary candour, and a degree of zeal exceedingly rare, at least among men of the author's years, Mr. Hey was no sooner apprised of the incorrectness of some terms in his original description of the anatomy of femoral hernia, than he determined to examine for himself the modern illustrations of this important subject. With this view he visited the schools of the metropolis, and with all the ardour of a youth entering on his studies, attended the lectures and examined the preparations of Mr. Astley Cooper. Such an undertaking however, was only accomplished at the imminent risk of his life. In the present edition Mr. Hey has in consequence amplified and illustrated by plates, with perfect accuracy, the anatomy of femoral hernia. In the preface he thus acknowledges and very satisfactorily explains his former misconceptions.

"When I first committed my papers to the press, the public had not been favoured with that elaborate and excellent work of Mr. Astley Cooper on Hernia. I had, indeed, read the treatise on femoral hernia by Don Antonio de Gimbernat; but had not profited by it as I might have done. For not understanding clearly, at my first perusal, his description of the posterior projection of the aponeurosis of the external oblique muscle of the abdomen, I incautiously laid the work aside;,

determining, however, to seize such opportunities as might offer of discovering the cause of stricture in femoral hernia.

"On such occasions, I pursued my examination in the following manner. Having laid bare that part of the fascia lata of the thigh, which covers the great femoral vessels, where they descend below Poupart's ligament; I opened the abdomen, and removed the peritoneum, together with that fatty membrane which lies at the entrance of the sheath of those vessels. I then dissected out the lymphatic glands and adipose membrane, which remained in the sheath on the inner side of the femoral vein.. Having cleaned these parts, I introduced my finger into the sheath; and, carrying it downwards on the inner side of the vein, till it appeared below what is now called the lunated or falciform process of the fascia lata, I took notice where the stricture upon my finger was the greatest. In doing this I found the anterior edge of the thin projection of the aponeurosis of the external oblique muscle, to coincide or be continued with the falciform edge of the fascia lata. This part I called the femoral ligament. My idea, however, of the anatomy of these parts was not clear when I first adopted that term; and, consequently, my description of them was obscure; though I am not aware that it led to any practical error."

Besides the great additions to the chapter on the strangulated her ia, and other considerable alterations in various parts of the work, the author has annexed to this edition three short chapters on the following subjects. On the hydrocele of the spermatic chord-a case of lithotomy in the female-a case of tumor on the nose. An appendix to the volume contains a case from Mr. A. Cooper of strangulated femoral hernia with mortified intestine.

We shall offer a very few remarks on some points of the work. The convex-edged saw which among us has pretty generally obtained the appellation of Hey's saw, deserves in our opinion, all the encomium which has been passed upon it. The trephine is an instrument which is often quite inapplicable, and has only kept its ground for want of a better; this is now supplied.

In his chapter on the cataract Mr. H. exposes the inaccuracy of the idea conveyed by some writers when they speak of