Cooper, and the description of it to the figurative genius of an author beyond the Tweed.

Of the phrenic hernia, our readers may recollect two dissections formerly published by our author in the Medical Records and Researches, which are here extracted. The causes are the dilatation of natural apertures, mal-formation, and wounds of the diaphragm. The second is the most frequent. Morgagni furnishes an instance of the first. Dr. Macauley's memoir in the Medical Observations and Enquiries, and the cases just alluded to are examples of the second; and the third is derived from the case of a ship-painter who died in Guy's Hospital in 1804. It is totally beyond the reach of art, and fortunately not very common. Cases however may be found in the writings of Hildanus, Paré, Petit, Schenck, and others. A lapse of the small intestines between the layers of the mesentery, which our author met with in the dissecting room, he terms, with sufficient propriety, the mesenteric hernia. We believe the case is now first described.

Extensive involutions and entanglements of the intestine are sometimes seen in the subject; and perhaps this variety of disease, from its rare strangulation, has escaped notice. A description and plate of a mesocolic hernia are likewise presented. As the sacs of these hernia are not enveloped by tendons, they are probably never the subject of stricture. Unfortunately the history of both is wanting. Several cases are lastly related of strangulation within the abdomen from three causes, First, apertures in the omentum, mesentery, or mesocolon. Secondly, adhesions from inflammation leaving an aperture. Thirdly, membraneous bands forming in the mouths of sacculi elongated by the protrusion and frequent returns of

viscera.

The concluding plate presents sketches of these appearances, and two views of the intestine of a dog united after longitudinal division, constituting an exception to the general results obtained by Professor Thomson. We have no hesitation to attribute the difference of effect which must be allowed to prevail in these cases, to the division of those circular fibres in the longitudinal wound, which in the transverse are only separated. The circular, besides being the strongest and most numerous, are situated most internally. The peristaltic motion requires the regular alternate contraction of both, In the transverse division the external and weaker are cut across; in the longitudinal, the internal and stronger. The suture may be used with equal impunity upon the inflamed as upon the sound intestine.

A case of double congenital inguinal, and crural hernia, is introduced in the form of a communication from Mr. Allan Burns, the diligent anatomist of Glasgow. The peculiarity of the former consists in the premature separation of the pillars of the external abdominal aperture, we suppose from a relaxation or total deficiency of the connecting fibres. We have a case of this description now under observation. The tumour of several years standing, is confined between the apertures of the inguinal canal, and instead of advancing through the lower it has dilated the tendon into a large pouch, and lost the visible character of hernia. In this case, which we believe was first noticed by Petit, the tumour takes an unusual inclination towards the spine of the ilium, and is upon the ilial side of the epigastric artery. From the following paragraph it is evident, that Mr. Burns had observed the fascia propria, and that he explains it by the protrusion of the fascia (or septum, as he calls it,) of the crural hole. How the sac should derive an investiture from the duplicature of Gimbernat, we are utterly unable to conceive, and fear that even the sagacity of Mr. Burns would be puzzled to demonstrate.

"With regard to the crural hernia, we found a peculiar disposi tion of Gimbernat's duplicature; the formation was not however exactly alike on both sides. On the left of which I have sent a drawing, the crescentic duplicature was pushed out so as to form an enclose for the peritoneal herniary sac. In order to understand how this appearance was produced, we have to recollect in some cases a septum is stretched across the crural aperture, being merely a small perforation in the centre. When pressure is applied to this septum, it is protruded, assumes the form of a capsule containing the herniary sac, and has a small opening in its extreme point. Over the upper and outer edge of the protruded duplicature lay the falciform process of the fascia vera; but in this instance it is obvious that the fascia might have been divided, without in any degree removing the cause of strangulation."

We must here close our analysis of this important work, to the standard matter of which it will be found more easy to append a criticism, than to oppose a fact.

It has thrown a new and brilliant light upon the tangible pathology of hernia. The abdominal ring, as it is called, was the ultima Thulé of our forefathers' excursions in the inguinal region* ; and a vaguely defined space comprised between

* Our well known obligations to the ingenious Camper are of a later date.

the

the ilium and pubes, was almost all the anatomy of our most eminent writers. Some spoke with modesty and a becoming caution, and hinted, obscurely indeed, the concern of more parts in the strangulation; others affected authority, and blazoned their ignorance by a captious and dogmatical pertness*. In no operation is the embarrassment of operators more conspicuous, and surely in none more alarming. Often have we seen the surgeon scratch and niggle with his scalpel at the distance of a finger's breadth from the intestine, and like. the traveller who has lost his way, "seem afraid to go forward least he should go wrong." The caution of ignorance is as little worthy of confidence as the boldness of empiricism. The supposed thickening of the sae, and its divisibility into layers, the feuillets which Duverney mistook for adipose cells, and Garangeot for the cellular coat of the peritoneum, are almost invariably mentioned by operators; but the idea that they are distinct fasciæ compacted by disease, seems never to have been conceived. The general doctrines of causes and symptoms, are detailed in the former part of the work, and they are delineated with much strength of character and accuracy of discrimination. The plates drawn for the most part by Kirtland, are engraved by Heath, in the style peculiar to the latter artist. Our metropolis, we lament to say, with all its comprehensiveness of excellence, does not boast a master in anatomical delineation. The works of Camper, Scarpa, and Soemmering, are at once our admiration and our shame.

We know of no example that better deserves imitation than that of Mr. Cooper. It is only by concentrating our observation that we can hope to add to the store of facts, which experience has already accumulated. Such insulated labours cannot be too much encouraged, nor too highly appretiated.The results of speculative efforts are like the ignis fatuus which gleams only for a time, and leads the traveller astray; but the effects of these practical investigations may be compared to the polar light which guides the mariner from the shoals and rocks, and shines with undeluding splendor.

The history of the disease whose seat, symptoms and treatment archere delineated from the life, may ere long be supplied

* Vid. A Treatise on Ruptures, Chap. I. 1783.

VOL. I. NO. 1.

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by our more erudite northern neighbours; and though the opportunities of literary labour lie within a smaller compass and are of more general attainment, than the opportunities of an equally extensive observation; they are not less deserving of the protection and encouragement of all, who desire to ennoble the profession that they are compelled to cultivate,

ART. IV. A Treatise on Insanity, in which are contained the Principles of a new and more practical nosology of maniacal Disorders than has yet been offered to the Public, exemplified by numerous and accurate historical Relations of Cases from the Author's public and private Practice : with Plates illustrative of the Craniology of Maniacs and Ideots. By P H. Pinel, Professor of the School of Medieine at Paris, Senior Physician to the Female National Asylum la Salpêtrière, late Physician to the Asylum de Bicêtre, and Member of many learned Societies. Translated from the French, By D. D. Davis, M. D. Physician to the Sheffield General Infirmary. 8vo. pp. 288. London, Cadell and Davies, 1806.

on

F any one will take the trouble to read the most esteemed I works on mental insanity, we have no doubt he will think with us, that the treatises on this subject are more than commonly uninstructive, and that when arrived at the conclusion of his task, he knew little more than when he began it. Whatever may be our opinion of the nature of this disease, whether we believe it to originate in a mental or a corporeal affection, it is still true that the present subject is partly medical and partly metaphysical, and that even if we could clearly ascertain how far the bodily functions are concerned in the derangement of the mind, a no less important question would still demand solution, What change does insanity produce in the faculties of the understanding? or, in other words, What is the difference between a sane and an insane mind? The mental may be the effect of the bodily affection, and yet the mind may open the fairest track to the disease of the body. It is upon the latter question that our books afford the least instruction. A multitude of cases are upon record narrated with the utmost minuteness; but we look in vain for a clear, precise, and satisfactory analysis of that mental affection under which the patient labours. Sometimes we find an attempt to supply this defect

defect by bad metaphysics, and sometimes are modestly told by the author that such investigations are useless. Unfortunately a rare concurrence of circumstances is necessary to the successful investigation of the diseases under consideration.

Those who superintend the management of the insane are seldom or never fitted either by the natural faculties of their minds, or the favourite line of their studies, to distinguish the essential features of any mental disease; whilst those who have attained more than ordinary aptness at seizing the subtle forms of intellectual peculiarity, are seldom thrown into a situation where they can apply this power to the extension of our knowledge. Those who have the faculty want the opportunity to observe, and those who have the opportunity want the faculty. An examination of the most probable sources of information, viz. the medical and metaphysical writers, leads to this short conclusion: that the physicians were dull, and the metaphysicians ignorant.

There is another cause, no less important, of the scantiness of our knowledge concerning mental derangement. The clearest source of facts relating to the nature of mind, is selfobservation. But during the existence of insanity the madman is incapable of self-observation; he cannot look within himself to analyze and explain the difference between the state of his mind now and when in health. The most valuable source of information on this subject is taken away, and we can only gather our knowledge by observing the actions and conversation of our patients, and tracing them through several steps of inference to their proper sources in the understanding. These we believe are some of the causes why the books which treat of mental derangement are more than usually empty. Authors have attempted to give a definition of insanity, as if it was an uniform disease, or as if all its varieties could be traced to one essential hallucination. Some think that it consists in an unnatural association of ideas; some in a præternatural strength of imagination; others in an extraordinary susceptibility to passion, either of pride, rage, or grief. The truth is that the unnatural state of the mind, called insanity, varies in different individuals, and that any opinion drawn from a few cases, will not be found universally applicable. Insanity is far from being a uniform disease. It is merely a term for a disordered state of the mind, which is marked by

one