not supersede simple excision. It is certain that this pricking terrifies the patient, nor when accomplished is the pain relieved. By incision the pain is transient, and the operation decisive, and is finished in a few seconds. We cannot say so much of the strangulation of the vein between the needle and thread. This occasions a little pain at first, but the pain must of necessity continue to increase, indeterminately, for several days; nor can we know in anticipation or perhaps in reality, to what extent, and how long a time it will continue and excite inflammation, as we will not have the power of limiting it to the simple grade of adhesion. The excited sensibility of the vein does not remain circumscribed to the point compressed. It extends easily along the vein, and there is danger that phlebitis will extend to the larger trunks, endangering the life of the patient. Nor is the inflammation confined to the vein. The integument and other parts which sympathise with it are likely to participate. It is not uncommon for gangrene to attack the integuments which surround the points compressed, and killed, by the pincers or by the needle and thread.

Resection, on the other hand, induces some loss of blood, which depends upon the operator favoring it or not, so that the inflammation of the wounded part may be circumscribed, which cannot be done with compression. Strangulation of the vein does not give confidence to the patient, who perceives always the uncertainty of the cure, without knowing the extent of suffering. Nor should we be surprised if after three or four days the sufferings of the patient should induce the surgeon to relax the compression, leaving him exposed to all the results of the experiment, which are not only useless in effect, but always pernicious, and may induce grave consequences.

In excision, the patient may be compared to a ship in a troubled sea, the wind having ceased to blow; while compression may be compared to a vessel which leaves the shore, throwing itself into an ocean, soou to suffer all the effects of an inevitable tempest, whose duration or termination canot be surmised.

Should the patient have enough of courage and patience to resign himself to events; uncertain whether adhesion will take place, or how much time must pass ere its accomplishment, well; if not, he will consider the operation a total loss. If it is performed in a place which may be obliterated, we may not obtain cure on account of the anastomosis of the obliterated vessel. If the varicocele is in both veins, the operation must be performed the second time, uncertain still whether compression is applied to the remaining vessel or to that which has been operated upon. Facts, in fine, in the cure obtained by strangulation, have proved, as has been said by Dr. Dufresne, that we always have more or less sup

puration. Nor can we guarantee the patient from the danger of secondary hæmorrhage, which, without the degeneration of the wound, cannot take place after excision of the vein. Subjected to an impartial examination, and placed in opposition to the advantages we may hope for, and the dangers we may fear, it appears to us that excision of the varicose veins merits the preference without regard to the choice of the patient.

Clinical teachers, who reason upon and compare the different methods, 'are authorized by experience, to form a judgment which will serve as a guide to the novice in the noble art of surgery.

BIBLIOGRAPHICAL NOTICES.

On Diseases of the Skin. By ERASMUS WILSON, F. R. S., Consulting Surgeon to the St. Pancras Infirmary; Lecturer on Anatomy and Physiology in the Middlesex Hospital School of Medicine, etc. etc. Second American from the second London edition. 8vo. pp. 439. Lea & Blanchard. Philadelphia: 1847.

Although we have many works on Dermatology, we can hardly be said to have yet arrived at any great degree of accuracy in our diagnosis of the various affections, and, as a consequence, their treatment remains for the most part empirical and often unsatisfactory. The greatest confusion exists in the classifications of authors. Affections are described as distinct diseases, which often co-exist, or become blended, so as to bid defiance to all attempts at satisfactory diagnosis. With some, the topographical system, which divides the diseases according as they affect the head or the body generally, has been prefixed; but more generally the system of Plenck, modified and improved by Willan, was for a long time adopted. It consists of six orders, characterized by the appearance of the eruption, which, instead of constituting the disease, is in fact merely one of its products. To this succeeded the so-called natural system of Alibert, which embraced all cutaneous diseases in one

group, under the name of Dermatoses. This constituted the trunk of his "Arbre des Dermatoses," the sub-groups being its branches. Although its gifted author assumed this to be the Natural system, in opposition to that of Willan, which has been designated the "Artificial system," it was really not any more simple, and hardly more correct in reference to the phenomena of the various affections. The great fault of Willan was in endeavouring to carry out the principles of division and subdivision pursued in Botanical and Zoological classifications; as if any analogy could exist between morbid conditions of a part of the human body and the natural or organic structure of plants and animals. In the attempt, affections the most dissimilar, as purpura and scarlatina, scabies and variola, were arranged together; whilst some of the most analogous, as variola and varicella, were separated. Our author adopts a new classification of his own, which he likewise proposes to call a "Natural system," though it differs greatly from that of Alibert, and is, we think, with much greater reason entitled to that character. According to Mr. Wilson's arrangement, Diseases of the Skin are thrown into four groups, viz.: 1, Diseases of the Derma; 2, Diseases of the Sudoriparous Glands; 3, Diseases of the Sebiparous Glands; 4, Diseases of the Hairs and Hair Follicles.

What is called the skin, consists, as we know, of various structures, having their appropriate functions; and this classification has reference to the particular organs of the skin which are especially implicated. Disease in these several organs again is various in its character; thus we have inflammation, which may be either specific, non-specific, asthenic, sthenic, &c. &c.; augmented secretion, diminished secretion, retention of secretion, &c. &c. Hence, the classification is based on the distinct anatomical characters of the organs involved; which certainly is the most natural ground of separation. The particular character of the diseased action which occurs in these different structures, forms again a very natural and proper ground for subdivision.

If this classification were generally adopted, and we think it will be, it would do much to remove the confusion which exists in the diagnosis and pathology, as well as the therapeutic management of cutaneous affections.

The first chapter of the work contains an admirable account

of the "Anatomy and Physiology of the Skin," embracing all the modern microscopical discoveries of the intimate structure of the derma, epiderma, and the included organs. This constitutes an appropriate, indeed, indispensable, introduction to the study of the diseases of which the work treats.

The concluding chapter contains a "history and description of the itch animalcule, or acarus scabei," and a "history and description of the steatozoon folliculorum," embracing some original and very curious observations.

We have read this edition of Wilson on Diseases of the Skin with unusual interest, aad cannot hesitate to recommend it as the most complete and satisfactory work on the subject now The value of the volume is much increased by the excellent illustrations it contains; these consist of eight highly finished plates, representing groups of diseases, and comprising in all sixty-one different affections.

A Treatise on the Structure, Diseases and Injuries of the Blood-vessels, with statistical deductions; being the Essay to which the Jacksonian prize for the year 1847 was awarded by the Royal College of Surgeons of England, with numerous additions. By EDWARD S. CRISP, M. R. C. S., Member of the Council of the Pathological and Medical Societies of London, &c. &c. Svo. pp. 354. London: 1847. With five Lithographic Plates.

The structure, diseases and injuries of the blood-vessels is an interesting topic to the physician and surgeon, but to the latter more especially: and we are, therefore, not astonished that it should be made the subject of a prize essay by the Royal College of Surgeons of England. From Mr. Crisp's account, fiftytwo deaths occurred in the British metropolis in 1846 from aneurism; and according to the Report for 1840 of the Registrar-General, one hundred and forty-seven persons died from aneurismal diseases in England and Wales for that year,-a small proportion, certainly, for so large a population, when we compare it with the number of aneurisms in one year in the metropolis.

Two works on the diseases of the blood-vessels have been chiefly known amongst us :-one by Mr. Hodgson, of Birming

1847.] Structure, Diseases and Injuries of the Blood-vessels. 677

ham, England, which was published upwards of thirty years ago; and that of our countryman Professor Nathan R. Smith, of Baltimore, on the Surgical Anatomy of the Arteries, the first edition of which was published about fifteen years ago. Both of these are valuable productions-doing great credit to their authors; but still there was sufficient room for the Essay before us; and the fact that it received the prize awarded by the Royal College of Surgeons of England for the year 1847, is sufficient evidence of its being possessed of real merit. Mr. Crisp states, that he has, for many years, paid much attention to this class of diseases, and that his residence in the neighbourhood of two large hospitals has afforded him many opportunities for witnessing operations, and watching the progress of these affections.

The descriptions of the different diseases are those generally received, although they are in some cases too brief. The pathological deductions are usually accurate; whilst the treatment is judicious. The author has taken considerable pains, too, in obtaining statistical details;—for instance, one single table of 551 spontaneous aneurisms, (so called) selected indiscriminately from the British Medical and Surgical Journals from the year 1785 to the present time, occupies a space of nearly forty closely printed pages. The table contains the authorities for each case, the age, sex, artery affected, habits, occupation, supposed cause, &c., operation, termination, cause of death, &c., and the name of the practitioner under whose care it fell.

To the work are prefixed five lithographic plates, the first representing an "arterial tree;" indicating by figures the order of frequency of the different situations of aneurisms; the others elucidating the structure of arteries, and certain lesions of the vessels. They are not signally good specimens of art.