1846.] ESTIMATE OF PHRENOLOGY. 463 &c., do not present themselves. The fact is then, that in chronic insanity there is usually the evidence of pathology, but it indicates a general and not a local disease of the encephalon; the proof exists, but it is not of the right kind. The author observes, "it is a very interesting circumstance to notice, that all who have to deal practically and professionally with mind, and who at the same time understand phrenology, recognise the light which it sheds on their pathr."-L. c. p. 404. Testimonies from various individuals are then adduced in support of this position from one of Dr. Combe's works. That much benefit has resulted from the systematic study of the mental powers, which has attended the discussions of Gall's theory, and especially from the great attention that has been paid to the broad distinctions so much insisted on as existing between the affective and intellectual faculties, we are quite prepared to grant; and herein the phrenological school has conferred great and lasting benefits on society. But beyond this, we believe little has been gained; at all events we must enter our protest against the author's assertion, that all persons engaged in mental training have derived the advantages from phrenology indicated in the above passage. In the course of this article several allusions have been made to the pamphlet of M. Flourens. We have only to add, that it contains many judicious observations all worthy of consideration; but we agree with M. De Wolkoff, that it is most reprehensible to mix up, as M. Flourens has done, religious doctrines with mere matters of science. As to the "Reponse," of M. De Wolkoff, it contains little worthy of remark; this author, however, although he informs us he had great joy, after a painful study of the metaphysicians, when the work of Gall fell into his hands, believing he had at last found the treasure for which he was so long seeking, does not, after all, seem very much satisfied with having, for these twenty years past installed in his library the works of the phrenologist in the place previously devoted to those of the metaphysicians. The following passage would rather indicate that he has yet to seek for that ultimate rest, all engaged in philosophic speculations so earnestly desiderate, a fixed conviction: "in discovering in the human brain a constant disposition of the convolutions, it is not surprising that the phrenologists thought they might well be the seat of the diverse mental faculties. But beyond this it is only a supposition, and, however probable this supposition may appear to be, it would be wrong to regard it as an indubitable truth."-Quelques Considérations au Réponse, &c., p. 8. Before concluding our remarks, it is due to Mr. Noble to state, that although we have, in the discharge of our impartial duty, felt it to be necessary to oppose the physiological views he has adopted, we are most ready to bear our testimony to the talent and extensive information he has evinced; and we cannot for this reason but regret that he had not selected a more promising field for their exercise. 1. DELLE ALTERAZIONI PATOLOGICHE DELLE ARTERIE PER LA LEGATURA ET LA TORSIONE. Esperienze et Osservazioni di Luigi Porta, Professore di Clinica Chirurgica nell' I. R. Università di Pavia. Un vol. in 4to. grande, di pag 439, con 13 tavole in rame. Milano, tipografia di Giuseppe Bernardoni di Giovanni, 1845. Experiments and Observations upon the Pathological Changes produced upon Arteries by the Ligature and by Torsion. By Louis Porta, Professor of Clinical Surgery in the University of Pavia. Large 4to. pp. 439, 13 copper-plates. Milan, 1845. II. ON WOUNDS OF THE ARTERIES OF THE HUMAN BODY, WITH THE TREATMENT AND OPERATIONS REQUIRED FOR THEIR CURE. By G. J. Guthrie, F.R.S. 8vo. pp. 97. London, 1846. In the remembrance of what has been effected for the investigation and the illustration of the pathology of the arteries and for the determination of the surgical proceedings their diseases and injuries require, by means of the labours of Hunter, Desault, Scarpa, Hodgson, Jones, Bell, Cooper, and last, though not least, Guthrie and the other army surgeons, we might have been disposed to declare that no part of the domain of surgery ought to be so assured as this, and none so securely regulated by fixed and wellestablished principles and laws. And yet here we have, just fresh from the press, an elaborate experimental treatise upon the effects of ligature and torsion from the pen of Professor Porta, and the report of a short course of lectures upon wounds of the arteries just delivered by Mr. Guthrie, in which he censures with a just severity the retention of modes of procedure in reference to these, which the information the profession has for years been in possession of, ought long since have induced it to discard. We certainly were not aware, prior to the perusal of these Lectures, that sound surgical and anatomical principles were still so much unknown, or so little regarded, even by men of great note, as the instances cited prove to be the case. It says little for the real progress of our art that doctrines which were laid down in 1815, as the results of extensive and diversified experience, and the correctness of which has never been successfully impugned, should require reiteration in 1846, and should receive additional means of illustration from some of the instances of the consequences of neglecting them, which have occurred in the interval. The treatise of Professor Porta is a very able performance, proving its author to be a worthy successor of the celebrated man who formerly adorned the University of Pavia. But, while testifying to the acute spirit of investigation, the felicity of exposition, and the pains-taking desire to arrive at the truth, which it manifests, we cannot conceal from ourselves the conviction that a considerable portion of it is a work of supererogation. Surely, after the elaborate investigations of Jones, Hodgson, and others, upon the effects of ligatures on the blood-vessels of animals and men, hundreds of additional experiments upon the former were scarcely called for; and indeed this portion must be looked upon rather as an elaborate demonstration or exposition of the whole case of the ligature, (or as 1846.] ANATOMY OF THE ARTERIES. 465 a repetition of such demonstration in a more methodical form,) than as the receptacle of any discovery, or the herald of any improvement. The author arrives at the conclusion that the present universally adopted mode of applying the ligature is the best-a conclusion he could have as well reached had he spent a somewhat larger portion of the nine years over which these investigations have been carried in his library, instead of in the performance of numerous cruel and unsatisfactory experiments. Yes, cruel; for, surely every unnecessary experiment is a cruelty, and many, very many, of these upon the different kinds of ligatures, which universal consent has abandoned the use of, and for the re-ascertainment of points already established, must be so considered. The conclusions, too, derived from the experiments upon the blood-vessels of animals are more unsatisfactory than those which bear reference to any other portions of the economy; these tubes being gifted with very different properties in different brutes, so as to render the reasoning from analogy respecting them an unsafe procedure. 66 Although," says Mr. Guthrie, "there is so general a resemblance between the arteries of man and animals, as to render them apparently similar, their structure is not exactly alike. A second cellular coat, for instance, is found between the external and middle tunics in the ox. It has not been practicable to cause an aneurism in dogs, and the apparent similarity of these vessels, with reference to the effects which may result from injury or disease, cannot be depended upon : nor can any confidence be granted to the numerous experiments which have been very cruelly made upon animals with the view of elucidating the various processes which occur in man." But while protesting against this part of the work as uncalled-for, though ably executed, we admit that other portions relating to the demonstration of the collateral circulation are more original in their anatomical demonstrations, though still leading to no novel conclusion or improvement in practice. The numerous facts cited from his own practice and that of various celebrated surgeons are however valuable; and altogether the work is highly useful to those (as we suppose is the case with many in Italy) who have not access to the other sources of information we have referred to. A brief analysis of its contents may also be interesting to our readers. In the first Chapter the Anatomy of the Arteries is treated of. The author, like other anatomists, describing these as consisting of three coats, the cellular, fibrous, and inner. Blood-vessels, which are found abundantly supplying the outer tunic, become smaller and smaller, and are gradually lost as they penetrate the middle one, so that they cannot in any wise be traced upon the innermost.* The nerves and lymphatics do not penetrate beyond the cellular coat. The external coat is then an eminently vascular membrane, and pathological changes in man, as well as experiments in brutes, alike prove it to be the seat of the principal vital phenomena and organic metamorphoses which take place in the arteries. The middle one resembles tendinous or aponeurotic structure, and seems destined chiefly to give form and resistance to the vessel, and to preserve its calibre without presenting an obstacle to the impelling action of the heart. The * The is a discrepancy in this statement of the author compared with that of the concluding sentence of the paragraph. innermost tunic is composed of a fragile, coriaceous pellicle-an arterial epithelium. This epithelium being lined with a serous membrane, is pretty vascular, but it is by no means so prone to take on inflammatory action as represented by some pathologists, although inflammation of the proper tunics of these vessels, which is denied by others, and is really of rare occurrence, may yet undoubtedly take place. In the Second Chapter the following questions are discussed:- What becomes of a ligature attached to an artery? Does the material of which it is composed influence the results of the operation? What is the most eligible material? Four descriptions of ligature were tried in the 300 experiments performed to illustrate these points. Catgut was employed 80 times, silk 120, thread 60, and horse-hair 40 times. The results are detailed at great length, but we need only advert to the general conclusions, viz. that of the 300 ligatures, 64 disappeared in periods varying from one day to two years, and 236 remained of these last, 29 were found amid a lymphatico-cellular tumefaction, 60 within the intermediate cord connecting the two ends of the artery, 67 enveloped in common cellular tissue, 54 enclosed in a true cyst, and 26 in the midst of suppuration. Our author considers the 64 which disappeared were assimilated (or more correctly speaking absorbed), and found a much larger proportion of the catgut ligatures underwent this process than those of any other material. Those results observed in animals differ from those observed in man by the much greater frequency with which the ligature excites the adhesive process in the former by which it is retained, and the suppurative process in the latter by which it is discharged. Signor Porta enquires whether these ligatures, which after amputation have had their ends cut short, as recommended by Lawrence (but seldom put into force by him now we imagine), and as treated by himself both after amputation and the operation of aneurism, and which are sometimes retained after the wound was united and never discharged by the suppuration, do not become dissolved or encysted. It may be so, but seeing how very rarely such a result can be calculated upon, we think so generally an unsuccessful practice should be discountenanced. In the Third Chapter the author discusses the various modes of applying the ligature and performing torsion, and the pathological changes which are produced upon the arteries by these. 1. On the Application of the Ligature.-Four kinds of ligature are described, viz. the common or circular, the temporary, the mediate, and the double. (A.) The Circular Ligature. With this ligature formed of various materials, the ends being cut off and union sought to be obtained, 140 experiments were tried on various arteries of different animals. From these the ordinarily described mechanical effects, division of the proper tunics, strangulation and approximation of the cellular tunic, and the formation of a coagulum on each side the thread, resulted. The obliteration of the vessel is due to the subsequent inflammation, which is so much more commonly of an adhesive character in animals than in man, that in 140 ex 1846.] EFFECTS OF THE LIGATURE. 467 periments the ligature was only discharged with suppuration 19 times. In man, a mixed process, termed by the author plastico-suppurative, takes place. 66 Operating by whatever mode we will, we can never hope to obtain in surgery the happy results derived from tying arteries in animals; but, judging from analogy, and from known data, I believe that when the ligature is applied in man with greater delicacy than it has hitherto been, choosing the most homogeneous material and the most simple procedure, respecting the cellular matrix of the vessel, cutting off the ends of the ligature, closing up the wound, avoiding the proximity of the aneurism, and enjoining the greatest quietude to the patient, we shall obtain adhesion much oftener; and that when, in spite of our efforts, suppuration does occur, it will be circumscribed, and will not impede the plastic exudation which closes up the mouths of vessels, and prevents those fatal accidents which, so exceedingly rare in animals, have so frequently endangered the life of man." As Mr. Guthrie's account of the effect of the ligature upon the vessels differs from that usually given, we will here extract it. "The inner and middle coats are not only divided, but the inner one particu larly appears curled inwards on itself, so that the cut-edge of one half or side is not applied to its fellow in the usual way of two surfaces, but by curling inwards meets its opponent on every point of a circle, and in this way forms a barrier inside that of the external coat, which is tied around it by the ligature: so that, in fact, when a small ligature is firmly tied, its direct pressure is not applied to the inner coats, which have been divided, and have curled away from it, but to the outer one, which is in consequence of that pressure made to ulcerate or slough, which processes could scarcely fail to take place also in the other coats, if they were subjected to pressure in a similar manner. The cut-edges, being from this provision of nature perfectly free, are capable of taking on the process of inflammation, which stops at the adhesive stage. This they do by the effusion of lymph or fibrin, both within and without, to a greater or less extent as the case may require. The outer coat of the artery must either yield by ulceration or sloughing, or the ligature must remain until it is decomposed and destroyed. The artery usually yields by sloughing, or the ligature is left at liberty by the ulceration which takes place in the sound part of the artery immediately above and below the part strangulated by the ligature, and which part is frequently brought away in the noose. The artery does not always yield by sloughing, particularly if it is a large one, and the ligature has been thick and soft. In this case, a part of the outer coat, from its folding or plaiting under the ligature, seems to escape that degree of pressure necessary to destroy it, and when the remaining part yields, it remains entire, and is only removed by a subsequent process of ulceration, occasioned by its irritation, as an extraneous body. I have had the opportunity and misfortune of examining great numbers of stumps after amputation and death, and I have seen this occur in so many instances as to leave no doubt of the fact. In these cases, the external cases could not close around the inner ones; and this shows that they are capable of forming an effectual barrier without it, although it materially assists in giving greater strength to the cicatrix by the effusion of fibrin, which takes place within, without, and around. "Whilst this process is going on without, and at the very extremity of the artery, the vessel is gradually contracted above it, and its coats become more or less inflamed, soft, and vascular. The inner coat is seen to be wrinkled transversely, and a small coagulum of blood is formed within it. This sometimes completely fills the artery, but it is more common for a small tapering coagulum to be formed, adhering by its base to the extremity of the inner coat. My ob |