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this material improvement the world is indebted to the late Mr. Pott, to whom Mr. Bell offers a juft tribute of praife.

In the directions for treating the inflammation which ufually accompanies fractures, our Author recommends the early ufe of aftringent applications, fuch as a folution of Sacch. Saturn. of Sa Ammon. or Spt. Minderer.' He infifts on the use of these applications, with a view rather to prevent the inflammation, than to remove it when formed. Inflammation is doubtless a fymptom which of all others demands the furgeon's chief attention, as its confequences are often fatal, frequently dangerous, and always troublefome. That the Author fhould, therefore, on fo important a part of his fubject, be diffuse, is more pardonable, than that he should be defective, or fail of giving full inftructions for the management of that fymptom, which, when prefent, is perplexing to the furgeon, and diftrefsful to the fufferer; and which, unless it be speedily removed, produces, if the patient escape with his life, long-continued pains refembling rheumatifm, contractions of the tendons, exuberancy of the callus, deformity of the limb, perpetual weakness and lamenefs, which are frequently attributed to the ignorance of the furgeon, or mifmanagement in the reduction of the fracture. Topical bleeding is the only effectual remedy for fuppreffing the inflammation arifing from the bruife of the foft parts; and Mr. Bell prefers leeches to the lancet; which he applies in large quantities all over the contufed part. There is, however, another kind of inflammation, which arifes, not from any external injury done to the foft parts, but from the irritations of tharp (plinters of the bone which are not properly replaced, or which are perhaps wholly detached: in fuch cafes, leeching is of no fervice; and as they feldom happen except in compound fractures, the harp ends of the bones can be fawn off, or the detached parts entirely removed; and in fimple fractures, the detached parts of the bone frequently preventing an union, an incifion may be made for extracting them; but this must be done with great caution, for fear of wounding the blood-veffels; and it muft never be attempted until other methods have failed.

Many caufes are enumerated which tend to impede the union of the ends of fractured bones, and proper directions are given. for the peculiar management of each cafe. As these causes are very various, and as it is impoffible that the method of removing one fhould fucceed in all, the Author has bestowed much labour in fhewing how they are to be known from each other. This circumftance is common to Mr. Bell, who is, as we have often

*Difcutient or repellent is the ufual epithet,

had

had occafion to remark in our review of his former volumes, peculiarly attentive to point out the diagnostics.

After having finished his general directions, he proceeds to confider the fractures of the nofe, of the bones of the face, of the inferior maxillary bone, the clavicles, the ribs, the Sternum, the Vertebra, Sacrum, Coccyx, the Offa Innominata *, the Scapula, the Humerus, the bones of the fore arm, wrifts, and hands; the thigh-bone, Patella, and the bones of the legs and feet.

Of compound fractures, and their management, Mr. Bell treats at large, in a separate section. The first object in these cafes is, to reftrain hemorrhages when they take place; the next is, to confider whether the furgeon muft attempt to fave the limb, or to recommend amputation. This is an important enquiry; and the Author gives it all the attention which its importance feems to require. He ftates the opinions of former writers; fhews the impropriety of rafh determinations; and gives a number of excellent general directions for the furgeon's conduct. He diffuades from immediate amputation in private practice, where patients can be kept quiet and perfectly at reft, and where proper attention can be infüred on the part of the furgeon, as well as of experienced nurfes, unless when the bones are fo thattered that they cannot reunite; or when, from the violence of the injury, the texture of the foft parts is completely deftroyed: but in the navy and army, he thinks it may frequently be neceffary to ufe immediate amputation, where the patient is expofed to a variety of hardships which tend to aggravate his danger, and where no accommodation can be procured nor attention given to leffen it. This practice, however, is ftill farther reftricted to fractures of the thigh and humerus, or where both the bones of the leg or fore-arm are broken.

When amputation is not performed immediately or foon after the injury, it ought not to be attempted for feveral days; different caufes may then render it neceffary. 1ft, Hemorrhages under certain circumftances: 2d, Extenfive mortification: 3d, The ends of the bones remaining difunited, while a copious difcharge of matter endangers the finking of the patient's ftrength. Each of thefe heads is diftinctly treated, and directions are given for determining when and how the operation may be performed.

In the 40th chapter, on luxations, Mr. Bell firft defcribes thofe fymptoms that are common to all diflocations, and gives the ufual general directions for reducing them. The fubfequent parts of this chapter are allotted to particular luxations, and their method of cure. The Author here proceeds in his usual

* We wish that this term was abolished.

manner,

manner, giving ample directions, on the most approved prin ciples, for reducing the diflocations, and retaining the bone in its proper place.

The next two chapters are on diftorted bones; in which Mr. Bell fhews how diftortions are produced, how they may be pre-. vented, and the means that are moft likely to fucceed in order to remove them.

The 43d chapter is allotted to the confideration and defcription of amputation; an operation which ought never to be performed where it can poffibly be avoided; yet as it is often the only means of preferving life, it is frequently neceffary, although it may be repugnant to humanity, diftrefsful to the unfortunate fufferer, and in fome circumftances fo fraught with danger, that nothing but a full and clear conviction of its neceffity can warrant the propofing it in any cafe. As to the operation itself, it is by no means difficult, and may be eafily performed by any perfon accustomed to handle inftruments; but to diftinguifh with precifion the cafes which require it, from those which might fucceed under a different treatment; and to determine the particular period when it ought to be performed, are circumftances which demand more deliberation than perhaps any other in the whole practice of furgery. Mr. Bell therefore enumerates the cafes where amputation may be neceffary, all of which are com prehended under the following heads. 1. Bad compound fractures. 2. Extenfively lacerated, or contufed wounds. 3. Limbs hattered by a cannon-ball. 4. Mortifications. 5. White fwellings. 6. Large and increafing exoftofes. 7. Čaries. 8. Cancers and inveterate ulcers. 9. Various kinds of tumours. 10. Diftortions of limbs. In the preceding cafes, circumstances often occur which render amputation the only means of preferving life; and in pointing out thofe circumftances, in determining when, and in defcribing how, the operation ought to be performed, the Author appears in the feveral characters of a judicious director, an expert operator, and a beneficent man.

To be able to alleviate the miferies of those who are obliged to fubmit to dangerous operations, affords the highest gratifica tion to the operator; and as pain is in general the most dreadfu! part of any operation to the patient, Mr. Bell has given a chapter containing the moft effectual methods of preventing or diminishing pain in furgical operations.'

Midwifery being now confidered as a diftin&t branch of practice, Mr. B. fuppofes that a minute account of it will not be ex pected in a fyftem of furgery. For particular information on this fubject, he refers to thofe authors who have profeffedly written on it; he hath nevertheless delineated the inftruments usually employed in midwifery, and defcribed two operations,

1

which, although immediately connected with this branch, are yet more frequently performed by the furgeon than the accoucheur; viz. the Cæfarian fection, and the divifion of the fymphyfis pubis. With refpect to this laft operation, we have frequently had occafion to condemn it; and the arguments which we brought against it in our 70th volume, pag. 205-208, will apply to Mr. Bell's opinions: we fhall not therefore repeat them; but we are forry, on account of the general excellency of the work, that this Syftem of Surgery fhould recommend an operation which every man of profeffional knowlege and humane difpofition must neceffarily condemn.-We with Mr. Bell had confidered this fubject more minutely.-He feems to have been influenced by the fpecious accounts of the French writers.

The remaining three chapters are on the opening of dead bodies, on embalming, and on bandages; in which nothing new

occurs.

Of the general merit of the work we have fpoken in the beginning of this article: the merits and defects of its several parts will beft appear from what we have advanced in our accounts of the former volumes *.

The Author affures the Public, that no attention shall be wanting on his part to render the work as complete as it can be; he means to infert in the fubfequent editions to which it may extend, whatever improvements future experience adds to Our prefent flock of furgical knowlege; and that the purchasers of the firft edition may not be affected by fuch improvements as may be inferted into any future edition, he will afford them. an opportunity of procuring fuch additions, or alterations, feparately.

We ought not to conclude this article without informing our Readers, that the engravings which accompany this work are accurately expreffive of what they are intended to reprefent. They are contained in 99 plates, neatly executed. The figures are generally on a reduced fcale. In moft cafes this circumftance is immaterial, but in fome it may lead to error. The figures of the inftruments, especially, ought to appear in their proper fize: this objection, however, is fomewhat removed by the very exact and minute defcription which the Author ufually gives of his inftruments, particularly if they are new, or any way materially different from those in ordinary use. R......m.

* See Review, vol. Ixix. p. 442. lxxi. 348. lxxvi. 35. lxxvii.

218.

REV. Jan. 1789.

C

ART.

ART. IV. Tranfactions of the Society inftituted at London for the Encouragement of Arts, Manufactures, and Commerce; with the Premiums offered, in the Year 1788. Vol. VI. 8vo. 4s. Boards. Dodiley, &c. 1788.

EVERY volume of this patio

VERY volume of these Transactions brings additional proofs

ftitution; and we are glad to find that the number of its mem bers is daily encreafing, which will naturally add fresh vigour to their exertions.

The propagation of timber was one of the firft objects that attracted the attention of this Society; and it must afford pleafure to every English reader, who is a well-wifher to his country, to find that the Public have fo cheerfully contributed to forward the Society's views in this refpect. From the memoirs in the volume now before us, we are cheered with a gleam of hope, that notwithstanding the general complaints of the decrease of oak timber for fhip-building in the fouthern parts of the island, where it has hitherto most abounded, a fupply will be raised in the northern parts of it that may in time fupply the demand. We have had occafion to mention, more than once, with juft applause, the extenfive plantations made by Mr. White, at Buttsfield, in the county of Durham, which we here learn continue to profper abundantly, fo as to encourage that worthy cultivator to extend his plantations there more and more, from year to year; and that, in particular, in the laft feafon, he planted no fewer than FIFTY THOUSAND OAKS; which have fucceeded in a furprifing degree. We here alfo find that the Rev. Mr. R. Lloyd, of Afhton, in the county of Salop, planted (in the autumn of the year 1784) SIXTY FIVE THOUSAND FOUR HUNDRED and FORTY OAKS, and fowed, befide, near ten bushels of acorns. Thefe plantations, which are all well fenced, and thriving, may come in time to be of great national importance; befide the benefit that will accrue to the proprietors of the barren fpots on which thefe improvements have generally been made.

But these plantations in England, though of importance, appear comparatively fmall when mentioned with thofe of much greater extent in Scotland. We have frequently heard furmifes that extenfive plantations of timber-trees are often made in that almost unknown part of the country, and have heard our old friend Dr. Johnfon blamed for not only having neglected to notice this circumftance, but for having even infinuated, in his famous TOUR, that no fort of attention was there paid to the raifing of timber; but never did we obtain fo fatisfactory a proof of the contrary as is here afforded by accounts of the extenfive and thriving plantations made by the Earl of Fife, in the counties

of

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