200,000 volumes, and has museums of various descriptions, where one of the professors often attends, particularly on public days, to explain the several collections to all persons anxious for information regarding the different objects there exhibited. This arrangement proves highly conducive to the diffusion of knowledge, and ought, therefore, to be adopted at every similar institution, wherever located. Of late years, several works of importance on medical subjects have made their appearance in Norway, which are creditable to native authors. Thus may be specified, as examples, the recent work of Dr. Danielssen, Chief Physician to the Leper Hospital at Bergen, "On Diseases of the Skin," illustrated by splendid plates; as likewise the joint production of Drs. Danielssen and Boeck, On "Spedalsked❞— Elephantiasis Græcorum, or Leprosy; while the malady is accurately displayed in drawings highly creditable both to artists and publishers. Other Norwegian medical publications might be alluded to if necessary, although the above seem sufficient to show that our northern confrères are active in promoting the practical study of medicine and the collateral sciences.

Analogous opinions may be enunciated with equal justice regarding a neighbouring kingdom, to which Norway was long attached under the same sovereign, and whose language the Norwegian educated classes still speak-namely, Denmark. In this island country, both medicine and surgery are zealously cultivated by able labourers in the field of science; while numerous works have issued from its press, of which other nations would not be ashamed. Further, the University of Copenhagen is considered one of the best throughout Northern Europe, and usually comprises about twelve hundred students in the four faculties. It has an excellent library, containing upwards of one hundred thousand volumes; and there may be seen besides, in the Danish metropolis, numerous magnificent museums well adapted for the cultivation of science, which would do honour to any capital whatever. Indeed, the richness of Copenhagen in many varied collections intended for advancing knowledge in nearly every department, fully entitles this city to the designation it has popularly received, of being the "Athens" of Northern Europe. Among its different museums, the Zootomical, in the University, may be specified, as being the richest of that description throughout the Continent. The Royal Zoological Museum-occupying one of the King's palaces, forms also a splendid collection; and as periodical instructive demonstrations are frequently given by curators, to all spectators who may choose to listen, as also by professors in respective departments, the valuable objects there accumulated become utilized in a way highly commendable; this plan might be often advantageously imitated in other countries, whose inhabitants sometimes vainly deem themselves superior in some features to the more modest Danes, with whom they are too little acquainted, particularly in reference to their educational and scientific establishments.

Prior to taking leave of Scandinavia, and the actual state of medicine in that distant part of Europe, which at one time, however, formed an

united empire, Stockholm, now the capital of one of its integral kingdoms, and usually designated the Northern Paris, must not be omitted from our present brief sketch, more especially as the subject is truly deserving of notice by the profession in England. Unlike almost every other European metropolis, the city just named has no university Upsala being still the chief Alma Mater in North Sweden. However, in lieu of such an institution, with reference to medical studies, there is the Carolinish Institute, where ample appliances exist for obtaining professional knowledge, quite equal to any university. This establishment has an extensive library, numerous teachers in the usual branches required by students, and several museums containing whatever may be wanted for their instruction, as also a maternity institution and large hospital adjacent, named the "Seraphim," where varied clinical teaching constitute prominent features. It should, however, be added, that to obtain medical degrees, students must still resort to Upsala, although great efforts are now being made to transfer that privilege to the metropolitan institution. Nevertheless here, as elsewhere, such an innovation is resisted by those in possession of ancient rights, against the attempts of other parties equally desirous of wresting the power of making M.D.'s from the hands of existing monopolists.

In no part of Europe does greater anxiety prevail to become acquainted with what may be passing in other countries, whether as regards science or medicine, than among professional men in Sweden, who, during late years, have not only often published important works in reference to medicine and on surgical questions, but also in reference to the collateral branches of knowledge. Moreover, Swedish practitioners are generally well-informed respecting foreign medical literature, of which two instructive examples, derived from our personal observation when recently visiting Stockholm, will suffice as apt illustrations. At the Carolinish Institution already mentioned, besides French, German, and the standard publications of other nations, there were noticed on its reading-room tables, not only indigenous periodicals, but those issued from various foreign capitals, including Dublin, Edin burgh, and London, among which we may enumerate This Journal, whose pages must have been often perused, if one might judge from appearances. Again, at the chief medical society somewhat analogous to the Imperial Academy of Paris, in addition to many continental journals on professional subjects, the members also frequently received important works published in Great Britain; this is very different to what usually prevails in France, as for instance, at the celebrated French medical corporation just mentioned. At that learned establishment, enjoying a high reputation everywhere, when recently visiting, we could not find any British medical periodical on its library table, excepting the London weekly return of births and deaths, forwarded gratuitously by the English Registrar-General. Such statements speak unmistakeably regarding the marked existing difference betwixt our Gallic and Scandinavian neighbours. This discrepancy may, however, be explained by the advanced position which France has virtually attained in the comparative scale of science and

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learning, if contrasted with residents in the more boreal regions, who feel ever anxious to obtain knowledge from any source, whether foreign or domestic. The former are, to quote the saying of an illnatured critical foreigner, oftener teachers than scholars of other nations, according to their own estimation; and usually believe themselves best entitled to lead the van, instead of following in the wake of modern civilization.

REVIEW XIII.

A System of Surgery, Theoretical and Practical; in Treatises by various Authors. Edited by T. HOLMES, M.A. Cantab., AssistantSurgeon to the Hospital for Sick Children. In Four Volumes. Vol. I., pp. 850.-London, 1860.

"A TENDENCY to greater exactness of thought in questions of cause and effect," it is remarked by one of the writers in the volume before us, "has been part of the general scientific development of our time -belonging not exclusively to medicine, but perhaps rather coming to medicine by contagion from physical and chemical studies. Fortunately, however, it has come to us." The appearance of a new work, long wanted, which is to comprise the whole range of surgical practice as understood in the present day in England, naturally leads us to inquire how it happens that such a work is new, and how it is that the want of it is only now to be supplied. It had long been felt that however high the standard of surgery had been raised in this country, it was not to the credit of the professors and practitioners of the science, that there was no modern work sufficiently comprehensive in its pages to compare with the productions of other countries, which at once gave a view of the whole range of the science and practice of surgery, and was at the same time the production of individual research and experience, rather than a compilation from the labours of other men. Contented to take their stand on ground they knew they could hold, it seemed as if the leaders and the teachers in the English schools of surgery were to be known by their well-earned title to safe and successful practical knowledge-the pride, as it is thought, of the practical Englishman; rather than by any claims they could put forward to higher honours gained by toil in the more laborious fields of original investigation and research. At all events, there was no single work, as a written record of the results of such labours, by which their high claim to pre-eminence could be tested, or from which it could be proved. Where the possession of such a title was not known, it could safely be called in question; and the high claims of the English schools could be challenged by others who, perhaps, looked around them from a lower standing on the slopes of the surgical Olympus.

The projectors of the work, of which one volume is now before the profession, have undertaken to supply the acknowledged deficiency; and for this purpose they have formed into a system" a collection of

essays or treatises by different writers on the numerous subjects comprised in the general term of "Surgery." The difficulty of obtaining qualified contributors to unite in the general plan of a work which should be a complete expression of the opinions and experience of many men; and, still more, to act in concert in the execution of it, and to perform with punctuality their engagements with their common editor and the professional public, has been one chief obstacle in the way of the completion of former undertakings of a similar comprehensive nature, though the hope of it has often been conceived by active minds.

The essays in the present volume, which are professedly limited to subjects of general pathology, are for the most part introductory to the fuller treatises which are to appear in subsequent volumes.

The opening essay is by Mr. Simon, who takes for his subject the pathology and treatment of Inflammation generally; a subject, he says, "of large scope and of equally large importance; the study of which seems to branch almost throughout the whole subject matter of surgery:" and he adds, "assuredly it is no exaggeration to say that rational surgery depends more upon a knowledge of the inflammatory process, than upon all other pathological knowledge put together." The inflammatory process, in its most characteristic type, is illustrated by the history of the rise of a carbuncle, and its progress, through the separation of the slough, and the healing, with the formation of a sound cicatrix. Mr. Simon, we see, calls it a slough, and minutely describes the microscopic characters which entitle him to declare it to be so. Hyperæmia invariably attends inflammation, and is essential to the inflammatory process, whether that be a destructive or a productive process; and it is seen in all forms of increased nutritive activity. It can go on for months without producing textural change, without causing a single pus-cell to grow, or a single texturegerm to die. A part is not inflamed because it contains more blood; it receives more blood because it is inflamed.

Our knowledge, such as it is, of the state of the capillary circulation in inflamed parts, is summed up by Mr. Simon in these conclusions:

"That within the area of stasis, the blood has lost the fluid in which its corpuscles should float; that the circulation of the corpuscles is delayed; that they collect against the wall of the capillary, as though by mutual cohesiveness, though they do not, when removed, seem more cohesive than in blood of healthy parts; that there is increased infiltration of the contiguous textures, and that stasis occurs with more or less facility in proportion as the liquor sanguinis is more or less transudable, and it does not result from alteration in calibre in the vessels of the part; that the cause of its production is an influence excited on the blood by textures within the area of stasis; that this influence is, mechanically speaking, of a suctional kind, which differs but in degree from that which the textures naturally exercise on the blood as it passes amid them."

The symptoms and causes of inflammation, as taught and described by former writers, much of whose doctrines may still be accepted as true, are traced with the closeness of investigation and clearness and comprehensiveness of arrangement which have distinguished all Mr.

Simon's former writings. The phenomena of inflammation are modified phenomena of textural life; the power which produces them is the power which produces the ordinary phenomena of textural life, and fully to explain inflammation would, in fact, be to explain life. Mr. Simon closes a valuable and instructive essay with a brief history of the literature of the subject; "the special study of which," he writes, "without undue partiality, an Englishman may be glad to say dates from the labours of John Hunter."

Mr. Coote contributes two short essays-one of them on Abscess. He gives in clear language, and in very few sentences, the most approved modern doctrine of the origin of pus: in behalf of which it must be said, as of much other learning that we labour to accumulate, that it seems a weak part of the doctrine that a writer is forced to confess that some of what is most necessary to the support of it "has yet to be proved." The possibility of the absorption of pus, though now known to be of frequent occurrence, rather than an occasional and very rare exception to a pathological law, is not yet universally admitted, if we may judge by the practice, still followed by some surgeons, of incising every fluctuating swelling. Where there is room for a doubt, there will generally be found some ground to support it; and of a soft and fluctuating swelling, which has been allowed to disappear without active surgical interference, it will many times be a question after all, which can never be solved, whether it was indeed pus.

The rules laid down for opening abscesses are liable, we think, to some difference in opinion. The bleeding lancet, if made, as lancets are now usually made for the pocket-case, sufficiently strong in the blade not to bend, and strong enough in the point not to break, we have generally found the most satisfactory instrument for opening the abscesses under the common integument; and these are the abscesses for which an opening is most frequently needed, or, perhaps we should say, is most frequently made. It is a less formidable instrument to produce in the sick-room, and we think it may be commended as doing the work sufficiently well. For chronic suppuration, for the abscess under the deep fascia, "a thin, yet broad-shouldered, sharp-cutting, double-edged knife, or scalpel," recommended by Mr. Coote, will be found more serviceable-greatly superior, according to our observation, to the curved cutting instrument, the bistoury, or the old-fashioned "abscess lancet." The rapid division of inflamed tissues, such as those generally lying over an abscess, of the integument especially, is attended with severe pain; and Mr. Coote's "rapid and bold plunge" of the instrument will often be found to give unnecessary pain in the beginning of an operation, at the end of which he justly condemns all probing and squeezing, as "a proceeding extremely painful" to the patient. The poultice, after the first application, may well be dispensed with; for it rather tends to keep up the suppuration, and by weakening the vessels, so far interferes with the recommendation to "leave the remainder of the cure to Nature." In connexion with several cases well related, Mr. Coote describes the different regions of the body in which abscesses are found sufficiently often to become sub