which he adopts. In teeth the subjects of decay a transparent zone, limiting the area of destructive action, may be seen, produced by the consolidation of the dentinal fibrils within the tubes. This zone of dentine being thus rendered hard and impervious, the diseased is isolated from the healthy portion of the tooth; hence, this condition is exactly equivalent to that which occurs in the case of inflammation or sloughing of soft tissue, where the parts which surround the inflamed area are infiltrated with serum or lymph, whereby the spread of the disease is arrested. This, at least, would show that vital action is at work, and cases are not wanting to prove that disease may not only cease, but that the carious surface may become hard and polished like the surrounding tissue. Again, in pregnancy the teeth often show signs of decaying suddenly, the tendency to disease ceasing after parturition. A like result occurs after certain severe diseases, and a change from one country to another may either develop or arrest carious action, the oral secretions continuing normal meanwhile; and we cannot but conclude that, although an abnormally acid condition of the mucus or saliva may be a source of disease, certain changes must take place in the structures of the tooth beforehand, and that therefore caries is the result of vital and chemical phenomena combined.

Other chapters are devoted to the consideration of ulcerations of the tongue, and of tumours seen in connection with the gums and other portions of the oral cavity, and merit particular attention, inasmuch as the dental surgeon often has the first opportunity of noticing diseases like epithelioma and cancer, which can only be cured when placed under treatment at an early stage of their development. It would not be within the limits of a review to enter very fully upon those portions of the book which are devoted to the correction of deformities by mechanical combined with surgical treatment, or to refer in detail to the various operations which are required for the cure or arrest of disease by plugging or stopping carious cavities. Wonderful advances have been made in these branches of dental art, many of the requisite operations being unsurpassed by any in general surgery in the neatness and skill which they require. Indeed, it is now rarely necessary to extract teeth which only few years ago would have been infallibly condemned. But with regard to the treatment of this most practical portion of the subject we think that -well described as is every operation mentioned-it is not quite abreast with the advances made, for many ingenious operations and novel means of treatment are not even mentioned here. Still, while making these remarks, it must be conceded to Mr. Tomes that what he has described has been described in a way

which could not be excelled in clearness and perspicuity of style. The book is a most valuable contribution to physiology and surgery, and the author will not feel it otherwise than complimentary when we give the chief praise to that portion of his work which treats of that minute anatomy to the elucidation of which he has so successfully devoted himself, and with regard to which he has obtained a world-wide reputation. The only suggestion we could make would be that, at some future time, the book might be conveniently divided into two volumes, one on anatomy and physiology, the other on dental surgery, which latter subject, as has been remarked before, might have been much more fully entered into; but, as it is, there is no work we are acquainted with which, taken as a whole, can be compared with Mr. Tomes's well-written and instructive manual.

IV.-Cooper's Dictionary of Practical Surgery.1

COOPER'S great work has found a worthy editor in the veteran surgeon Mr. Samuel Lane. Though the value of the book has been considerably diminished by the long interval which has elapsed between the appearance of the first and second volume, this has probably been unavoidable, from both the great labour involved and the difficulty of keeping a team of collaborateurs in order, but it will prove our excuse for devoting more attention to the second than the first volume, the contents of which are, of necessity, somewhat behind the day.

The last edition of the Dictionary,' edited by Mr. Cooper, contained 1500 closely printed pages in one volume. The present edition consists, as we have said, of two volumes, each containing over 1000 pages, of the same size and type as before. Antiquated material has been excised, so as to leave some 700 pages for new matter, which has been apportioned as follows: -249 have been allotted to articles on new subjects, 280 to rewritten articles, and the remainder to emendations of existing articles, these being conveniently placed within brackets, so that the reader can easily ascertain whether the author or the editor is writing. The names of the contributors include many of the leading surgeons and writers of the day, and

1

Cooper's Dictionary of Practical Surgery and Encyclopædia of Surgical Science. New edition, brought down to the present time. By SAMUEL A. LANE, Consulting Surgeon to St. Mary's and to the Lock Hospitals; formerly Lecturer on Surgery at St. Mary's Hospital; Member of the Court of Examiners of the Royal College of Surgeons. Assisted by various eminent surgeons. In two Volumes, Vol. I, 1861; Vol. II, 1872. London.

since it would be impossible in one article to do justice to all their contributions, we propose to select one article by each as a specimen of the kind of work to be found in this veritable Encyclopædia of Surgery.

The article ANESTHESIA, by the late Dr. John Snow, which did not see the light until after the author's death, gives an excellent account of anaesthetics up to the time at which it was written, and the writer was able to speak with the authority of great experience respecting the administration of ether, chloroform, and amylene. Whilst giving a general preference to chloroform, Dr. Snow allowed, candidly enough, that ether possessed one important advantage in its greater safety, but he pointed out its greater difficulty of administration, owing to the lowering of temperature due to evaporation-a point which may be well borne in mind during the present, probably temporary, reaction in favour of this agent. The great point in Dr. Snow's article appears to us to be the way in which he insists that if a patient is in a condition to be submitted to an operation at all, he ought to have the advantage of anesthesia, since the pain he would otherwise suffer would depress the system more than the inhalation. This is a point too often lost sight of.

Mr. Erichsen is well known to have paid great attention to the subject of ANEURISM, the article on which is edited by him. As a bibliographical record of the various views held at different times, Mr. Cooper's original article is unrivalled in English surgical literature, and Mr. Erichsen has made such additions on the subject of treatment by pressure, &c., as were needed. The article is now, however, of course, somewhat antiquated, and should be supplemented by the perusal of Mr. Erichsen's chapters on the same subject in his 'Science and Art of Surgery,' or Mr. Holmes' article in his 'System.' The impetus given to the treatment of intra-thoracic aneurisms by the distal ligature by Mr. Heath's successful case of double ligature, the treatment by genuflexion, the improved methods of applying galvanism, and last, but not least, the revival of the catgut ligature by Mr. Lister, have all occurred since the date of this essay. It is very instructive to read how we work in a circle, and how many modern improvements are but revivals. Take, for example, Mr. Porter's suggestion to apply a temporary metallic compressor to an exposed artery, and we have but the revival of Assalini's forceps and other metallic instruments, of which, as Scarpa remarks, "they are liable to all the inconveniences which are inseparable from the presence of hard bodies introduced and kept for several days in the bottom of a wound, especially when this is recent, in which case they cannot be retained in a proper direction without difficulty, or exactly at such a depth as will not be

attended with hurtful pressure upon the wound itself and important parts in the vicinity." The catgut ligature, again, was used by Sir Astley Cooper with perfect success in one case, without the addition of the carbolic acid now so much relied on to perfect the cure, but it failed in other cases, both in Sir Astley's and Sir P. Crompton's practices; and in the last volume of the St. Bartholomew's Hospital Reports' is recorded a case of fatal secondary hæmorrhage following ligature of the femoral with catgut, followed by antiseptic dressing.

6

The article CANCER has been considerably expanded by Dr. Handfield Jones, who has given the views of Paget, Walshe, and Rokitansky, as generally held at the date of writing, but, necessarily, does not refer to the growing belief in the local origin of cancer, as maintained by De Morgan and Arnott. The question of the prolongation of life by operation does not receive any extended notice in the article in question, and it may be well, therefore, to remind our readers of Mr. Sibley's and Mr. Morrant Baker's recent papers in the Medico-Chirurgical Transactions,' in which statistics are brought forward, which confirm Paget's general statement that "the average duration of life in unoperated cases is something more than two years, in operated cases is something more than twenty-eight months." Mr. Sibley, whose statistics are drawn from the records of the Middlesex Hospital, says, "in the cases of cancer of the breast, those who have been operated on lived fifty-three months, whilst those in whom the disease was allowed to run its natural course lived only thirty-two months." Mr. Baker, whose data were drawn from Sir James Paget's practice, says, "the average length of life in scirrhous cancer is forty-three months when the primary disease is not removed, and fifty-five months when the operation is performed; whilst in the case of medullary cancer the results are even more striking, being twenty months without, and forty-four months, or more than twice the time, with an operation.'

CARIES has received some small additions at the hands of Mr. Spencer Smith, who has, however, omitted the long details formerly given of the methods of removing carious bone. In fact, Mr. Smith deprecates operative interference altogether, and though we should not go to this length, we agree with him in thinking surgeons are too apt to look to the local mischief alone, and to ignore constitutional causes. Many cases of caries of internal parts would doubtless heal if they were not constantly irritated by probing, and were gently stimulated by the injection of some simple lotion.

CATARACT, by Mr. White Cooper, occupies five-and-twenty pages, and might have been said to be quite out of date were it

not that ophthalmic surgery has come round in fifteen years again to some of its ancient practices. The old operation of extraction by the large corneal flap is the one form of extraction here described, and it will be remembered that this gave way to Von Gräfe's method of a limited corneal incision, followed by an iridectomy, and to the spooning out of the lens by Schüft or Waldau. Then it was found possible to extrude the lens without the spoon, and iridectomy was abandoned by some ophthalmic surgeons, who returned either to the large section or to Liebreich's incision through the sclerotic, a structure hitherto totally proscribed. In congenital cataract the introduction of the operation of "linear extraction" has been of great service by freeing the eye, at an early period, of irritating particles of lenticular matter and diminishing the number of needle operations, and thus Tyrrell's great feat of operating upon children has been perfected.

The two articles DISLOCATIONS and FRACTURES have been edited by Mr. James Lane, who has devoted to them and to his other contributions an amount of labour quite remarkable. The old and almost universally received views of Sir Astley Cooper on these subjects have of late received some rude shocks, more particularly in regard to the action of the muscles, in both classes of affections. Thus, the late Mr. Syme was strong in maintaining the non-necessity for extension in cases of fracture of the thigh, though he did not go to the extent of Jobert de Lamballe in doing without apparatus altogether; and Bigelow has done much to disabuse surgeons of the idea that muscular contraction is the great impediment to the reduction of dislocations, by showing that it is sometimes necessary to tear the hole in the capsule of the hip-joint larger, before reduction of the head of the femur can be effected.

The treatment of dislocations by manipulation rather than by forcible extension is yearly making progress, and will soon as completely supersede the old plan with the pulleys as modern anæsthetics have the bloodletting and nauseating doses of tartar emetic of bygone ages.

Hamilton's standard work on fractures and dislocations has appeared since one, at least, of Mr. Lane's articles written, and so also the work of Bigelow on the hip, to which we have referred above, and there is a lack, therefore, of reference to American views which we find in more recent authors.

The classical works of Malgaigne and R. W. Smith, of Dublin, have, however, been largely referred to in both articles, and Mr. Lane has gone carefully through each of the numerous forms of fracture and dislocation described by Cooper, and has added such illustrative cases and new methods as to increase