"The cause of this affection is shewn by the stream of urine being obstructed in its passage from the bladder; from its not having that equal and proportionate egress out of the urethra as it is poured into the urethra from the bladder. The contracted prepuce makes a pressure upon the glans penis, by which the urine recoils upon the neck of the bladder, irritating and inflaming it more and more, till the bladder, and in process of time, the kidnies, become as much diseased from this cause, (as the following cases will demonstrate) as they possibly can be, from any other cause whatsoever.' The cases do not appear to us perfectly conclusive. In the operation for phymosis, which the author recommends, he only divides the inner duplicature of the prepuce. He employs a small billhook knife, a plate of which is given; we shall give his description of the operation. "About the sixth of an inch of the outer cutis, is to be divided from within outward; so that the point of the knife shall be seen passing out, and dividing about one-sixth of an inch of the outer cutis; and this is all of the outer cutis that needs to be divided. This will naturally enable as much of the cutis as is divided, to be slid back; when only the duplicature will present itself; as much as does present itself must be divided in the same manner. This will allow fresh undivided duplicature to present itself, which is also to be divided after the same manner; and so on, till the whole is thus divided, and till the whole can be slid back behind the glans penis, leaving it completely denudated. "The treatment of the part is to be according to the principles of common surgery; to be dependent upon the degree of inflam mation, and the previous habit and age of the patient. One point must be always attended to; the prepuce must never be suffered to remain, for any time, slid back, as in one instance, where that was the case, it was with the utmost difficulty, that I could again bring datids upon it, and in the shortest time it forward. The strangulated glans had hy must have sloughed away. When the consequent inflammation will permit it, the prepuce should be slid backward and forward two or three times in a day, and whilst that was doing, the glans should be smeared over with oil of almonds. This will be sufficient in the simplest cases, and the whole will be well in a fortnight." A plate is given with the second part, shewing the instrument for injecting the bladder. It is simply an elastic gum bottle, to the neck of which is fixed a flexible catheter. ART. XXXV. Anatomical Plates of the Thoracic and Abdominal Viscera, for the Use of Students in Anatomy, and Artists; accompanied by explanatory Maps. By ROBERT HOOPER, M. D. Fellow of the Linnean and London Medical Societies, resident Physician to the St. Mary-le-bone Infirmary, &c. &c. THE title of this little work suffici ently explains its contents. The size of the plates is the same as that of the author's reduced Albinus, and as the parts here represented are larger and not so much involved as the muscles, the stu dent may obtain from them a very good general idea of the situation of the tho racic and abdominal viscera. They have every claim to be as well received as the former fasciculus. ART. XXXVI. A Diagram of the Human Eye. A Single-coloured plate giving a very accurate transverse section of the eye much magnified, accompanied with a short explanation. ART. XXXVII. A AN enlarged coloured view of the external and internal ear. The explana tion is not so full as that of the eye, and Dr. Hooper has equally omitted to men The exact ratio of enlargement is not mentioned; the length of the figure is nine inches, which well adapts it for demonstration in a lecture room. Map of the Human Ear. tion the natural dimensions. From this plate the operation of puncturing the tympanum may be seen witl. great correctness. ART. XXXVIII. The Anatomy of the Human Body, Vol. III: containing the Nervous System; with Plates. Part I. The Anatomy of the Brain and Description of the Course of the Nerves. Part II. The Anatomy of the Eye and Ear. By CHARLES BELL, Fellow of the Royal College of Surgeons of Edinburgh. 8vo. THOUGH nominally a third vo- considered separately, the two former lume, this work may with propriety be volumes being written by a different author, and the present being only connected with them as it completes the joint design of the two authors, in giving a comprehensive system of human anatomy. A writer, himself an accurate and practised anatomist, and in a situation to avail himself of the best published authorities, will find a greater treasure of curious, beautiful, and recondite anatomy on the subject of the nervous system, than on any other part of anatomical science. Who is unacquainted, by report at least, with the admirable works of Scarpa, Vicq d'Azyr, Zinn, Somerring, Monro, Walter, and many other men of eminence, whose lives have been devoted to anatomy, and who have made the nervous system their peculiar care? But, even to follow the demonstrations of these excellent anatomists requires a very considerable share of previous knowledge, both of that substantial kind which is gained by long and dexterous use of the knife, and of that familiarity with artificial distinctions and points of controversy which is acquired by consulting books. It is but justice to Mr. Charles Bell to say, that he appears well qualified for the task he has undertaken; his drawings, some of them original, in the particular point of view in which they are represented, and his general mode of description, shew that he does not teach merely by rote, but from personal experience, and the authorities which furnish the basis of his work are of the best kind, and well selected. The work before us is chiefly anatomical; with small admixture of physiological discussion, or any other of the many interesting enquiries connected with the functions of the noblest organ of the human body; and as simple anatomical description of intricate parts is of all things the most intolerable to read without plates or preparations, or dissected subjects, we shall content ourselves with giving a cursory view of the contents of this volume. The author begins with a very slight introductory view of the nervous system, chiefly relating to the structure of the brain and nerves, of ganglions and plexus. The mutual dependency of the nervous and circulating systems is thus described. expansions in the organs of the senses, are dependent for the perpetual renewal and support of their function upon the circulation of the blood. We should be tempted to imagine, that the nervous system were a nobler part of the economy, did we not fre quently see the powers of the mind as well as the functions of the nerves disturbed, or altogether overthrown by the irregularities of the bodily system; were we not thus reminded of that circle of connexions and mutual dependency which support the whole. If the tide of blood flow too rapidly upon the brain, the intellect is disordered sion. If the exit of the blood from the the ideas come in rapid and irregular succeshead be obstructed, there is an obstruction to the circulation of the blood in the extremity of the vessels of the brain; the fune tion of the brain is suddenly suppressed, because, though its attributes seem so peculiar, it requires the perpetual circulation of the blood through it to renovate its powers. "The effect of the circulation of the less remarkable. If the nerve of a limb be blood through the nerves of the limb is not cut or tied, the animal can no longer move the limb, having lost the power of the will over it. But if the great artery of a limb be tied, the function of the nerve is, in a short time, equally destroyed; because the circulation of the blood through the nerve being obstructed, its loses its powers, and is no longer a living part." circulation of the blood are dependent on the Thus, whilst the moving powers of the state of the nervous system, the nervous system is as immediately dependent on the healthy state of the blood, and the velocity of the circulation." Though the interruption of the func tions of the nervous system, by a derangement in the other parts of the ani mal economy, does not absolutely invalidate the term nobler part of the system, it is very proper to point out the de pendence of the nervous, on the arterial functions. The anatomical description of the membranes of the brain, and the texture of the brain itself forms the subject of the first chapter. The veins and sinusses follow, and are described with care. The author is willing to attach considerable importance to the glandule Pacchioni, or small tubercles appearing like silk-worms' eggs, as the inventor describes, and studding the inside of the longitudinal sinus. Mr. Bell conceives, that they act as valves to the veins that open into this sinus. The use of the sinusses of the brain «The brain, the nerves, and the nervous is an important speculation. Mr. Bell gives the following observations on this pelled " the impulse may not be com subject. "The importance of the sinuses in the circulation of the blood in the brain, is either vaguely described, or imperfectly understood by authors. We find it said, that the sinuses support the blood against compression, and protect its free circulation. This to me seems an erroneous idea. The lesser veins are as in other parts of the body, and have no such provision; and since, within the head, there can be no such partial compres sion as in the limbs, any cause which would compress the greater veins, were they not supported, must fall upon their extremities with worse effect. The circulation is the only power which can act mechanically upon the brain; but this can never cause a compression of its veins, because the increased action of the arteries must tend more to the distention of the veins than it will be the occasion of the brain compressing them. The more general idea conceived of the use of the sinuses is nearer the truth; viz. to prevent the sudden and violent action of the muscles of respiration, or of the muscles of the head and neck, from repelling the blood into the vena cava, or internal jugular veins; and consequently preventing the impulse from being communicated to the blood in the small and tender veins of the brain, which might endanger a rupture of them. Yet this is not exactly the manner in which the sinuses preserve the lesser veins; they do not suffocate nor take off the force of the impulse from the regurgitating blood, so much as they would do if they were like the trunks of veins in other parts; because, being incapable of distention, they throw the undulation of the blood, when it is thus checked in its exit, backwards upon the extremities of the veins. But then the effect is, that no particular vein or trunk receives the shock; all suffer in a lesser degree, and equally, which is their safety. All the veins in the base of the brain, which would be liable to rupture, or distention, from receiving, in their sudden turns, the shock of the blood, checked by the muscles of respiration, or otherwise, are preserved by being inclosed in sinuses, and covered by the strong lamellæ of the dura mater. The lesser vessels again are removed from the shock: its force is spent, because it has spread among many branches; and it has become a general impulse upon the brain, which the brain resists, because it is incompressible." Monro's explanation of the use of the sinusses, to which the author refers, in a note, is not given quite correctly. Dr. Monro does not say that the sinusses prevent the repulsion of blood, by the sudden action of the muscles of respiration into the vena cava and internal jugular, but that when the blood is so re municated to the blood in the small and tender veins of the brain, which would endanger a rupture of these,” and in confirmation of this opinion, he adds, that "generally a very small quantity only of any liquor injected into the sinusses enters the small veins of the brain and cerebellum." The ventricles of the brain and origin of the nerves are described in the fol lowing chapter. Mr. Bell takes Willis's arrangement of the nerves, allowing only nine of the encephalon; whence the facial and auditory is included in the seventh pair, the glosso-pharyngeum, the vagum, and accessorium in the eighth, and the sub-occipital or tenth of Willis forms the first cervical pair, as Haller has proposed. We shall give a single specimen of the author's talents for anatomical description, that our readers may form some opinion of the execution of the work. Let us take part of the description of the par vagum, as being one of superior importance. "The par vagum is the great and important division of the eighth pair. It is the middle fasciculus of the three nerves as they lie within the scull. In its exit, it is separated from the internal jugular vein by a thin bony plate; and sometimes two or three fibres of the nerve pass the bone distinct from the others, and afterwards unite into the proper trunk of the par vagum. Deep under the lower jaw and the mastoid process, the glosso-pharyngeal nerve, the par vagum, the spinal accessory, the sympathetic nerve, the portio dura of the seventh, and the upper cervical nerves, are entangled in a way which will fatigue the dissector, and may account for every degree of sympathy of parts. The par vagum, lying behind the internal carotid artery, and as it were escaping from the confusion of the ninth accessory and glossopharyngeal nerves, descends and swells out into a kind of ganglion. We now observe three branches to be sent off: the first and second pharyngeal nerves, which pass to the constrictor pharyngis muscle, and the internal laryngeal nerve. This last mentioned nerve is even larger than the glosso-pharyngeal nerve. It is behind the carotid ar tery, and passes obliquely downward and forward. In its progress the principal branch passes under the hyo-thyroideus muscle, and betwixt the os hyoides and the thyroid cartilage; while others, more superficial, pass down and are connected with the external laryngeal, or pharyngo-laryngeus; which is a nerve formed by the sympathetic, and par vagum conjointly. The principal branch of the internal laryngeal nerve, which runs under the hyo-thyroideus, is distributed to the small muscles moving the cartilages. The minute extremities of this nerve pass also to the apex of the epiglottis, and the glandular membrane covering the glottis. We have, at the same time, to remark a very particular communicating nerve betwixt this internal laryngeal nerve, and the recurrent branch of the par vagum. This branch is described by Galen. The par vagum continues its uninterrupted course betwixt the carotid artery and jugular vein, and is involved in the same sheath with these vessels. In this course down the neck, it sometimes sends back a twig which unites with the ninth pair, and when near the lower part of the neck, it sends forward twigs to unite with those from the sympathethic nerve, which pass down to the great vessels of the heart, to form the superior cardiac plexus. On the right side, these nerves to the great vessels are in general given off by the recur rent nerve. "The par vagum now penetrates into the thorax by passing before the subclavian artery; it then splits into two. The main nerve passes on by the side of the trachea, and behind the root of the lungs; while the branch, on the right side, turns round under the subclavian artery; on the left, under the arch of the aorta, and ascends be hind the trachea to the larynx. "This ascending branch of the par vagum is the recurrent nerve. On the right side it is sometimes double. It ascends behind the carotid artery, and sometimes is thrown round the root of the thyroid artery. On the left side, which, from its turning round the arch of the aorta, is much lower than on the right, it gives off filaments which go to the lower cardiac plexus, after having united with the branches of the sympa thetic. Under the subclavian of the right side, also, there are sent branches from the recurrent to the cardiac plexus; and on both sides there pass branches of communication betwixt the sympathetic nerve and the recurrent. When the recurrent nerve has turned round the artery, it ascends in a direction to get behind the trachea, and it lies betwixt the trachea and esophagus. It here sends off many branches to the back and membranous part of the trachea which pierce this posterior part, to supply the internal membrane. It gives also branches to the esophagus and thyroid gland. The final distribution of this nerve is to the larynx. It pierces betwixt the thyroid and crieoid cartilages, and separates into many filaments, which terminate in the crico-arytenoideus lateralis and posticus, and thryo-arytenoideus, and in the membrane of the larynx. We have already mentioned the branch of communication betwixt the recurrent and internal laryngeal nerves, and Sabatier describes a branch of the recurrent, which sometimes ascends and joins the sympathetic high in the neck. ANN. REV. VOL. II. "Two cases, mentioned by Galen, of scrophulous tumours in the neck opened, where the consequence was loss of voice, have tempted many anatomists to institute experiments on the recurrent and internal laryngeal nerves. Notwithstanding the deep situation of those recurrent nerves, Galen says, they were cut in these cases, and he believed that the branch of communication betwixt the laryngeal and recurrent restored the voice after some time had elapsed. Both the internal laryngeal and recurrent nerves are necessary to the formation of the voice. Experiments have been made upon them in dogs, and the result is curious; although the lesser changes of the strength, acuteness, and modulation of the voice could not be well observed in the lower animals. When the laryngeal nerve is cut, the voice is feeble but acute; when the recurrent nerve is cut," there is a relaxation of those muscles moving the arytenoid cartilages which command the opening of the glottis, and in consequence the voice is flatter or graver, or more rau cous." Thus we see that the par vagum has a most appropriate name, and that it is nearly as extensive in its connections as the sympathetic itself. It is distributed to the sophagus, pharynx, and larynx; to the thyroid gland, vessels of the neck and heart, to the lungs, liver, and spleen, stomach, duodenum, and sometimes to the diaphragm.' The recollection of this distribution will explain to us many sympathies; for example, the hysterical affection of the throat when the stomach is distended with flatus, the exciting of vomiting by tickling the throat, the effect which vomiting has in diminishing the sense of suffocation, that state of the stomach which is found upon dissection to accompany hydrophobia, whether spontaneous, or from the bite of a dog." The second part is devoted to the organs of the senses, of which the eye and the phenomena of vision, occupy (as from their importance they well deserve to do) a large portion of the volume. The ear, both of man and of other animals, is also considered much at large. The chapter on vision begins with a short abstract of the most essential propositions in optics, perhaps rather too brief for the very minute description of parts which follows. We shall not analyze this chapter, as the matter is too copious for condensa tion. A few observations may be made on particular parts. The following is at favourable instance of the author's accuracy of remark. "There is a circumstance in the operation of extracting the cataract, which I have seen 3 D but little attended to, and yet it is sufficiently evident. When the cornea has been cut, operators, disappointed in not finding the cataract protruded, keep the eye staring in the light, and press the ball of the eye; but while the eye is thus exposed to the excitement of the light, the pupil is contracted, and the lens propelled by the action of the muscles; and, still more, by the pressure made on the eye-ball, is in danger of bursting through and tearing the iris. The best operators have been in the custom of shutting the eve-lids the instant the incision was made in the cornea; by this means, the eye is for a time supported in some degree during the violent spasm of the recti muscles, and the iris being allowed to dilate, the lens is protruded into the anterior chamber of the aqueous humour through the pupils, and is ready to slip from under the cut cornea, when the eye-lids are again opened. By this means, if the incision of the cornea is of the proper extent, the lens is not extracted, but is protruded, by the action of the muscles of the eye." In describing the effects of light on the retina, we rather expected to have found some notice of Buffon's experiments on ocular spectra, and of Dr. R. Darwin's close imitation of them. They certainly deserved a place, on account of the important physiological observations deducible from them. On the membrana pupillaris the author, after describing its structure, gives the following original explanation of its use. "To explain the effect of this membrane, then, we have only to consider that it is of the nature of the iris to contract its circular fibres during the operation of light, so as to close or nearly close the pupil, that, on the other hand, the pupil is completely dilated through the operation of the radiated fibres of the iris in darkness. To the question, then, why it is not dilated during the foetal state? the answer, I think, is decidedly this: The iris is not loose in the foetal state, it is connected and stretched to the middle degree of contraction and dilatation by the membrana pupillaris. Were the iris in a full state of contraction, during the life of the foetus, it could not receive its full nourishment, proper degree of extension, and due powers; but being preserved stationary and extended, the disposition to contraction, which it must have when the retina is without excitement, is counteracted, until it is about to receive, by the birth of the child, that degree of excitement which is to keep up the preponderance towards the contracted state of the pupil." The much agitated controversy concerning the method by which the eye adapts itself to different focal distances, the imagined encrease of convexity in the cornea, the supposed muscularity of the crystalline, and the other questions relating to this subject, are collected with industry, and detailed with fairness. It is a little surprising, however, that the author, in giving an abstract of Dr. Young's most ingenious paper (the Bakerian Lecture, in the Transactions for 1801) should have overlooked the most important experiment of all (we mean that of enclosing the eye in water behind a convex lens, and ascertaining the same change of focal distance) and one on which the inventor himself justly lays the greatest stress. Mr. Bell appears equally deficient in the conclusions which he draws from all the experiments on this subject. After acknowledging himself entirely undetermined which hypothesis to adopt, he thinks proper to reject all, and from the following reasoning. "I have often doubted, whether these experimenters were not in search of the expla▪ nation of an effect which has no existence. I have never been able to determine, why a of a short-sighted eye should be so permavery slight degree of convexity in the cornea nent during a whole life-time, notwithstanding the perfect elasticity of the cornea, and its being so adapted as to alter its convexity by the action of the muscles. Again, a nearsighted person, with the assistance of a concave glass, can command the objects to the distance of some miles, and with the glass still held to the eye, can see minute objects within three inches of the eye. Now, I cannot conceive how the concave glass should give so great a range to the sight; as there can be no change in the glass, it must be the eye which adapts itself to the variety of distances; yet, without the glass it cannot command the perfect vision of objects for a few feet. Again, a short-sighted person sees an object distinctly at three inches from his eye; at twelve feet, less distinctly; and when he looks upon the object at twelve feet, the objects beyond it are confused, just as in other men's eyes; but when he directs his attention to the more remote objects, those nearer become indistinct. Now this indistinctness of the object, seen when he examines narrowly the object beyond them, would argue (did we admit this muscular power in the eye of adapting itself to objects), that the cornea or the lens has become less convex, were we not previously convinced that the utmost powers of the eye could not bring the object at the distance of twelve feet, or any other intermediate distance, to be more distinctly seen than the fixed and permanent constitution of the eye admits." |