185

Ventral Hernia.I do not know that there is

My thing in this kind of herniawhich reqùue& a distinct notice.When it.occurs’ low down, caremust be taking- in operat,ing,-,ofthe epigastric artery’; but ofthis your anatomical knowledgewill put you on your guard. Theintestine generally protrudeseither through the Lineae semi-lunares, or linese transverse ofthe abdomen which become en-larged.- ,

..

At the conclusion of the lec-ture Sir ASTLEY stated to theclass that the diseases of the eyenext came in order, and thatMr. Green had for some yearspast been in the habit of deliver-ing the lectures on those affec-tions, therefore that gentlemanwould begin the -subject nextMonday evening. ,

-

SIR ASTLEY COOPER, BART.

A Portrait of Sir ASTLEY

COOPER, engraved -by Mr. AL-DAIS, from a drawing by Mr. J.W.RUBIDGE, has been just ppblish-ed by Mr. Cox, and Messrs.HURST and ROBINS80N. Theengraving, in point of mecha-nical execution, is g-ood; -it hasevery merit, except that for

which the friends and admirersof this distinguished Profes-sor would most esteem it,—wemean, resemblance to the’ origi-nal. The air of extreme juve-riility which it gives him, re-

minds us of some of the engrav-ings which liave been recentlyput forth as portraits of ourgracious Sovereign: The law

ascribes moral perfection tothe Sovereign of these realms,by supposing that he can

do no wrong; and paintersinvest him with physical pre-eminence, by imagining that

he can iiever.giow’ old. Thesefictions are, no-doubt, sage andsalutary in respect to the King,but we see no necessity for ex- tending’ the privilege of peren-nial youth to the King’s , sur-geon ; and we had rather see a

portrait exhibiting- Sir AsTLEY,as we are accustomed to ’ seehim, in the- maturity of years, aswell as of reputation. The con-tour of the forehead, and the ad-justment of the bairare correctlydelineated; but ’the artist ap-pears to us to have failed alto-gether in catching- the promi-nent features of Sir ASTLEY’Scountenance. There is an airof mild intelligence in this

portrait, .but it wants . the spiritand expression which belong tothe original.

PHRENOLOGY.

We understand that a Courseof- Lectures is shortly to-be de-

186

livered 0)1,’ this science, by Dr.WILLIS. Dr. W. has investi-gated the subject very minutely;and we have no doubt that hislectures will,be highly instruc-tive. We hope that the dissec-tion of the brain, according toGALL’S system, will be includedin the course.

LIZAR’S PLATES. -

The drawings Qf the brain forthis splendid work have beensent from Edinburgh, and are nowexhibiting at Mr HIGHLEY’S, thepublisher, in Fleet-street, pre-vious to their being put into thehands of the engraver. Thereare, also some fine specimens ofthe fourth part, which is nearlyready for publication. Westrongly recommend members ofthe profession and anatomicaldraughtsmen to avail themselvesof the opportunity of inspectingthese admirable specimens of thegraphic art.

To the Editor of The Lancet.

SIR,—Together with severalstudents of our School of Ana-tomy,* I have been particularlyinterested in the case ypu have* The School of Anatomy alluded to

is not mentioned; but we infer it isthat of St. Bartholomew’s, and thatthe teacher whose opinion is quitedis lklr. ABERNETHY.—ED.

; reported in the three last num- ber,s of. THE LANCET, of theman on whom Sir A. COOPERi performed the operation of am-° putaticin at the hip joint.’ It has been impressed upon usby o,i,ir teacher, that there canbe no proper case for amputatingso high, and extracting the bonefrom the joint. He brings strongarguments before us te make! good his assertion, and supports’ his doctrine with regard to se-veral cases in which the opera-tion is generally allowed to beperformed, with sound reason-ing and by the demonstration ofmany specimens of the diseasesof bones.

Proofs and actual preparationsare, however, weak in their in-fluence upon some fellow stu-dents, compared with what SirA. COOPER’S practice may effectupon their minds. This youare aware of; and let that cir--cumstance be my excuse for re·

questing you to give us an ac-count of the condition of thelimb after the operation, ndwhether the femur was dis-eased higher than the place ofthe lesser trochanter. The im

portance of the question is greatand this is a very. proper oppor-tunity for discussing it. Byyour description of the dissectionlet our Professor have the ad-vantage of another proof con-cerning this subject; and at thesame time another proof of the

: liberality with which your LAN-CET is conducted.

! I ain, your obedient servant,INCISOR.

Feb. 3d, 1824.

We are perfectly aware thatin the history of JONES’S case,

187

which we communicated to the

public, there are two defects.-First ; the slight account of theman’s state previous to the ope-ration, which was owing to thevery short notice that was givenof it, thereby preventing us

from obtaining those particularswhich we otherwise should have

acquired.—Secondly; what is

so properly complained of byour correspondent viz. ---the

omission of the appearances of

the removed limb. This arose

from the bone not having beenexhibited, a circumstance whichwe exceedin-ly regret. No ope-rator should ever omit, in justiceto those who are present; andto his own’character as a sur-

geon, to exhibit the parts whichare removed, in order that all

may see the reasons for which

the operation was performed.-In consequence of Sir ASTLEY

COOPER having omitted to do

this, an impression exists in theminds of.some, that he was not

justified in the course he adopt-ed, of removing the limb fromthe joint. Had the appearancesof the bone been shewn to the

students, the profession wouldthen have had sufficient data for

judging of the propriety or im-propriety of the operation, andthe present impression would

most probably never have ex-isted.

From the number of opera«tions performed at the Boroughhospitals, some persons thinkthat the knife is occasionallyresorted to in cases where it

might be dispensed with. In

answer to this, we would

only state at present, that the

size of these institutions shouldbe borne in mind; and the cele-

brity which the surgeons be-longing to these institutions,haveobtained for their skill in the

use of the knife. We must con-

fess, however, that a greatrage for operations exists at

the Borough; the pupils are ex-

tremely anxious to see them

performed, and the surgeons

appear equally anxious to ob-tain a reputation by performingthem. The surgeons and stu-

dents of surgery, however,should remember that thereis something else besides the

mere mode of operating-thatthere is another important pointconnected with operative sur-

gery-the time when operationsshould be performed. To know

how to operate well, a man must

possess some manual dexterity,and an acquaintance with ana-tomy ; different operations re-

quiring these qualities in a dif-

188

ferent degree. To know whenoperations ought to be. per-.formed, and when they eughtnot, requires more extensive at-tainments, and can only be

learnt by those who investigatedisease, and :watch, its effects

.with a degree of attention

.which few seems disposed to

.bestow. The principles of

medicine must be thoroughly- understood. An acquaintance- with various remedies, diet and

temperature., on various com-

plaints, must also be possessed-knowledge which can only be at-tained by the most laborious stu-dy and diligent observation.-

To remove a limb,or to come to

see it removed, demand little ex-ertion on the part either of -thesurgeon or student, comparedwith a patient examinationinto the nature of the disease,for which the operation is to-beperformed ; and of the chancesof amelioration a patient maypossess, from the trial of different

means on the complaint underwhi.ch he labours. There are

some cases in which there can-not exist a doubt as to the pro-priety of operating-; .: where, onthe prompt skill of a surgeonthe life of a patient depends.We do not wish to discouragethe performance of operations,

when they are necessary ; but

we make these remarks on ac-

count of the misdirection which

the minds of the students appearto receive from looking only atthe manner in which the operator uses the knife, without

ever enquiring into the reasons

for which the operation is per,.

formed.- -

-

HOSPITAL REPORTS.,

Carotid Aneurism. Case con-

tinued from the last Number,page 156.

Guy’s. HOSPITAL:—Saturday,Jan. 31st. Passed a very rest-

less night on account of the painin ,the top of the head and

down the left arm ; sick at the

stomach, but has not thrown up;pulse 150, small ; respiration30; tongue furred, but moist;bowels open ’twice; took, twopills with calomel and opium,and has slept pretty much since;ligature came away this mOl’n.

ing; wound not united; dis-

. charge pretty copious.

Feb. 1st.—Rested very’little:pain in the head and arm gone,but is griped and has severe painbetween the umbilicus and pubes,tenderness also in that part onpressure; sickness at the sto-