regard to the influence of the same diseases on similar bodies of troops in almost every quarter of the globe, sufficiently ample to afford the means not only of testing the accuracy of our previous conclusions, but of extending them much farther than has hitherto been deemed prudent."

For this very reason we forbear indulging in any observations of our own. When the final reports and deductions are before us, it will be time enough to apply the individual experience of the medical man to the generalizations of statistics. We will content ourselves at present with remarking on the general ability displayed by Major Tulloch, and on the absence from prejudice and bias which he shews. Perhaps this very candour and impartiality may be carried rather far, and breed a degree of scepticism unfavourable rather than favourable to the discovery of truth, in sciences which do not admit of demonstration. Be this as it may, it is a fault on the right side, more particularly on subjects where speculation has hitherto been rampant, and assertion vaunted as truth.

We would earnestly direct the attention of our readers to these Reports. We repeat that they do not merely concern our troops and colonies. They affect the very primary doctrines of medicine, and they materially affect, or should affect, our practice. They have given the death-blow to the expatriation of invalids affected with pulmonary alterations. They serve also to shew us the salubrity of our calumniated climate, and to lower our aspirations for that "sweet South," whose sunny skies and luxuriant plains too commonly smile but to betray. Statistics dispel those illusions of poesy, and even prove that consumption, the reproach of our fickle seasons, lurks as fatally in the balmy Italian Zephyr, or the sultry tropical breeze.

THE RETROSPECTIVE ADDRESS IN SURGERY, FROM JULY 1836, TO JULY 1839, delivered before the Meeting of the Provincial Medical Association, at Liverpool, on the 24th July, and published in the Eighth Volume of its Transactions. By J. H. James, Esq. Surgeon to the Devon and Exeter Hospital. 8vo. Pp. 92.

MR. JAMES has published this Address, which gives an account of what has been done in surgery for the last three years. He follows in the wake of Mr. Crosse. The Address does not require any lengthened notice from us, as most of what he states may be found in our own pages. We need only allude to a fact or two, and an opinion.

Weight and Pulley for Fractures.-" M. Josse, of Amiens, has proposed a plan of treating these fractures by permanent extension, and in a few words it may be stated to consist in fixing the foot to the bottom of the bed, which is raised, so that the weight of the head and trunk being depending, produce a constant extension along the plane. To this some inconveniences must attach, although they are not much regarded by the proposer. I may perhaps be permitted to say that, nearly two years before M. Josse's work was put into my hands, I had

adopted the same principle, but carried it into effect in a different, possibly it may be thought a preferable mode, viz., by fixing the superior part of the body to the head of the bed, which is raised, and making extension on the limb by means of a weight fixed to the leg, properly guarded, and acting over a pulley, assisted also by a very simple apparatus, which it would occupy too much time to describe here." 20.

We would observe that it has long been customary to employ a weight and pulley to extend the limb in cases of threatened consecutive luxation of the femur from disease of the articulation. We cannot say that we ever saw much good in that case.

Necrosis. The difficulty of penetrating the hardened case of new bone when long formed, is too well known to require any comment; and it not unfrequently happens that any attempt to reach the sequestrum is either rendered abortive thereby, or occasions such a degree of disturbance to the whole shaft, as to produce more harm than good. Mr. Guthrie, to whom I allude, has availed himself of the peculiar properties of a remedial agent recently introduced (to which I shall again have occasion to refer)—the chloride of zinc, which, attacking the animal tissue of the bone, destroys it, and thus causes the earthy matter to soften and become detached. The sequestrum is by this means exposed with little pain or disturbance of the part, and may be dealt with according to circumstances. To the success of this plan I can myself most willingly testify." 43.

New Terms in Medicine.-" Another topic to which I feel it my duty to advert, is the remarkable fondness for the introduction of new terms in every department of medical science. Without for a moment questioning the propriety of abandoning those which manifestly involve an error, there were many free from any objection of this kind, because, purely arbitrary, and it would have been safer and perhaps better to retain them than to adopt others founded on scientific discoveries, in some cases questionable and liable, like their predecessors, to be reversed. Those who have witnessed with sufficient attention the repeated alterations which have occurred in our own times, will smile at the confidence now expressed in the immutable character of the technology of the day. A change of terms must be a positive good or a great evil. Amid the multiplicity of matters which engross our attention, it is very possible that confusion may arise, for we have the difficult task of unlearning what it has cost us some pains to acquire, and of learning that which is liable to be indistinctly impressed on our minds, just as one sign painted over another is often imperfectly portrayed. If new terms however are to be introduced, it would be well if they were checked by some competent authority, and not be thrown out the unlimited issue of individual speculation. For this evil I see no remedy at present except in the general jealousy of the profession, but that ought to be exercised to keep the prevailing spirit within moderate bounds." 81.

The Address is characterised throughout by good sense.

THE PRESENT STATE OF OPHTHALMIC SURGERY IN FRANCE AND ENGLAND COMPAred.

A SERIES of Lectures lately published in a contemporary Journal, as delivered by M. Velpeau, on the Diseases of the Eye, suggest a comparison between the doctrines and practice of the French and English surgeons in reference to ophthalmic surgery. The Lecturer himself commences by defending his own country from a presupposed charge of inferiority to Germany and England, and throughout the lectures, there is instituted a running comparison with the two countries, and not always, we think, a just one. From the tenor of these discourses therefore, we were insensibly led to the analysis of differences in theory and practice between the French and English hospitals and the refutation of some doctrines, which it seemed to us were founded in error. From this half-unconscious labour we soon became convinced that, by a more systematic analysis of the contents of the whole series of lectures, useful facts might be elicited, and interesting conclusions drawn, for the benefit of our readers.

Leaving the question of who first led the way to the classification and more accurate study of the diseases of the eye -as one of only remote interestwe proceed at once to the surgeons of the present day, who have in both countries devoted some portion of their time, more especially to these diseases, and who, by their writings, have contributed to the advancement of this fragment of surgical science.

In reference to English surgeons M. Velpeau remarks, "we cannot, I confess, bring forward so many pure ophthalmologists, but I appeal to your reason, is it necessary to be decorated with the name of oculist to have exact notions respecting diseases of the eye? Do not these affections belong to pathology in general? And ought not every good surgeon to be acquainted with this branch of his profession as well as with all others ?"

That it is not necessary to be decorated with the name of oculist in order to have exact notions respecting diseases of the eye, we not only most cordially agree, but without a knowledge of pathology generally, we hold very lightly any "notions" the pure oculist may entertain. It is precisely, therefore, for those English surgeons whom M. Velpeau quotes, and many to whom he does not allude, that we claim a high merit, if not a ground of superiority over their neighbours. They were among the first to rescue from the hands of mere oculists this important class of diseases, and replace them within the limits of general surgery. Thus the Lecturer would scarcely term "pure ophthalmologists" Travers, Mackenzie, Wardrop whom he quotes, or Lawrence, Guthrie, Tyrrel, Middlemore whom he does not mention. They have made the most valuable contributions, and indeed effectually proved that general scientific attainments, and the knowledge and practice of surgery in its most comprehensive sense form the best guarantees for the sound and judicious practice of this particular branch.

However, an invidious comparison between the individuals of different nations is by no means our object-but by analysing the doctrines of the most eminent surgeons of each, to trace out differences in practice-balance their respective merits, and so arrive at useful conclusions.

We are told" the school which reigns in France at the present day is No. LXV.

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that of Beer-it reposes chiefly on two principles-1. Diseases ought to be classed according to the natural system—that is, according to their physical symptoms-2. The classification should also be founded on the nature of the disease which may be considered the consequence of the first. "Such are the principles which have given birth to scrophulous, rheumatic, and catarrhal ophthalmia."

From these principles it appears that M. Velpeau entirely dissents-that is," he differs entirely from those who maintain that a disease of the eye assumes peculiar symptoms because the patient's constitution is modified by a general affection."

Although a little farther on we find that he acknowledges the influence of general affections upon the eye, and believes that they exercise the same influence over these as of all other diseases, yet he conceives the division of ophthalmia into scrophulous, rheumatic, and catarrhal, is altogether erroneous. The whole of this strong difference of opinion, and the whole error he attributes to Beer and his followers, he declares to be simply this, "they judge of the constitution by the appearance of the eye, whilst we ought to judge of the eye by the constitution."

This strikes us very strongly as little better than a jingling of words, wherein there are great distinctions with small differences.

By what means do we ever judge a patient to be scrophulous-is it not by the development of the disease in some tangible form? If a child is brought to a surgeon with a thickened lip-tumid belly-enlarged glands in the neck—or a slow enlargement of the knee with little pain, without any obvious cause, he forms his opinion that these are the signs of a scrophulous habit, and directs his treatment accordingly. If many of these signs are wanting, but instead there is an affection of the eye marked by excessive intolerance of light-a disease of long standing-with considerable action, but little power-on which local treatment produces no effective amelioration is it not equally rational to assume this to be a type of scrofula developed in that organ ?-and if our treatment, based upon this assumption, leads to the rapid amelioration and ultimate cure, are we not warranted in believing the diagnosis correct? Where then is the error of judging of the constitution by the character and progress of a disease in the eye. But, says M. Velpeau," nothing is easier than to give rise in the healthy eye, by artificial means, to an inflammation assuming all the symptoms of the scrofulous, &c."

We confess we are exceedingly sceptical on this point, and certainly, during a tolerably extensive experience in the treatment of ophthalmic patients, we can recall to mind no observation to confirm it. Doubtless every scientific surgeon will draw his conclusions from the general state and appearances of the patient, in addition to any specific disease in the eyes; but should no other indications exist, would M. Velpeau then reject the evidence of these diseased organs and treat them as a mere local affection ?-if so, the prognosis would assuredly be of the most unfavourable kind—and but a very short time ago we could have furnished him with a case strictly scrofulous in all its characters, which yielded only to treatment based upon such diagnosis, and having previously resisted all other prophylactic measures, although no other signs of scrofula were manifest.

M. Velpeau would always judge the eye by the constitution, and doubtless

so do those from whom he expresses so strong a dissent-if there be a difference between him and his confrères of the French school, it amounts simply to this, they take into their consideration such evidence as the diseased organ presents, in addition to any constitutional signs, while M. Velpeau entirely rejects it-admitting the while that "general affections exercise the same influence over diseases of the eye that they exercise over all other diseases."

To this it seems, so far, are M. Velpeau's claims to originality restricted, and as we cannot altogether believe that a surgeon of his standing and experience really rejects, as he would imply, the index which the principal disease affords to the constitution, we may for the present consider the difference in his opinions of no very solid character, and take him as our guide to the doctrines and practice of the French school of the present day. These lectures are first devoted to the inflammatory diseases of the eye-lids and globe, laying aside every thing relating to degenerations of tissue, and we are farther reminded that he does not take into consideration the constitution of the patient or the different specific causes of disease! Sounds this not remarkably like the announcement of the part of Hamlet-left out by particular desire! If indeed this be the mode in which the diseases of the eye are studied and treated by the French school, then we might assuredly at the outset congratulate our countrymen on a difference of the highest importance, for no Lecturer of the present day, we think, would attempt to instruct his pupils by setting aside all considerations as to the constitution of the patient, or the different specific causes of disease, and indeed M. Velpeau, as early as the second lecture, abandons his own plan.

He groups the different inflammatory diseases of the eye-lids under the general term of blepharitis, presenting varieties according to the nature of the tissue primarily affected, and to the variable intensity of the inflammation-these he further defines into five classes.

The classification of the various forms of blepharitis into mucous, glandular, granular, ciliary, and purulent, offers little novel or worthy of remark; it is generally adopted in Europe. The granular form of blepharitis is erected into a distinct class or form of inflammation instead of being arranged, as it is almost invariably observed-viz. as a consequence of catarrhal or purulent ophthalmia. The catarrhal disease itself commences in the mucous follicles of the conjunctiva palpebralis, and when it has continued for a certain period, the papular state denominated granular results; but it is maintained in these lectures, that there is a peculiar, a granular inflammation," which, in common with English surgeons generally, we cannot admit.

Again, with regard to the purulent blepharitis of new born children, M. Velpeau observes that this has been improperly confounded with purulent ophthalmia, with the Egyptian, and gonorrhoeal. Their unity is objected to on the grounds that the two latter do not so much attack the palpebræ as the eye itself, and the purulent ophthalmia of infants is almost entirely confined to the conjunctiva palpebralis.

In England it is pretty generally taught that these are essentially the same disease, varying greatly in their degrees of intensity or virulence, but the same in site the same in leading characters.

Nor can we for a moment admit the accuracy of the view set forth by the EE