been expected than that which renders a great part of his poetry unintelligible. A very simple statement, to which every reader assents as he reads it, is made a very serious business by the introduction of some mighty Heathen in its support. For example; an old man having said, "I sleep right oft, I wake right oft," the phrase is explained to express the short interrupted slumbers that naturally accompany old age, and this seems entirely satisfactory, but Mr. J. is not satisfied: for Euripides knew this; and what is more he wrote two verses to say so, and they are in the Iphigenia in Aulis; and Mr. J. knows where they are; and they are as follows, Μαλα το γήρας -. T.. Another quotation also is made which we cannot avoid giving, for the beauty of the introduction. This account of the birth of Robin Hood is certainly very characteristic, and perfectly consistent with his subsequent life and conduct, insomuch that it cannot be said of him as Dejanira says of Hercules, “dissimiles hic vir et ille puer."-We cannot, however, refuse our acknowlegements of obligation to an author who, with so marked a propensity to quotation as Mr. J. possesses, and a discovery so convenient for his purpose as that a passage should be cited merely because it is inapplicable, has suffered us to escape with so little molestation.

Hitherto, we have chiefly considered those faults in the work before us which relate to the editor's collection of ballads: but it betrays also some that are sufficiently grating to the reader's feelings, which have no connection with it, relating solely and entirely to the writer himself. This gentleman is continually making his appearance in his own proper person, starting up in the midst of Sagas and Eddas, to torture the nerves of compassionate men with very lamentable but somewhat unintelligible complaints of the miseries of his destiny. Our sympathy must always be deeply engaged by observing the struggle of genius through poverty and misfortune: but it is repelled by the obtrusive lamentations of those who complain of the cruelty of being obliged to endure the common hardships of life, and to gain an honest subsistence by the exertion of their own powers.

For the Glossary, we were preparing a rigorous destiny, but the article is already sufficiently long. We shall therefore just observe that about one half of the difficult words occur in it, and that of these a considerable number are ill explained, while many others are inserted and charitably interpreted which are at this day good current English.

ART.

ART. IV. The Anatomy and Surgical Treatment of Inguinal and Congenital Hernia. By Astley Cooper, F.R.S. Surgeon to Guy's Hospital. Illustrated by Plates, Folio. 21. 28. Boards. Cox, Johnson, &c.

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HE circumstances, which render the treatment of hernia an object of peculiar importance to the operator of surgery, cannot be better expressed than in the words of the present author:

No disease of the human body, belonging to the province of the surgeon, requires in its treatment a greater combination of accurate anatomical knowlege with surgical skill, than hernia in all its varieties. Symptoms immediately threatening the extinction of life occur at times, and in situations, that afford but little oppor. tunity for consulting the authority of others, and demand in the surgeon a prompt resolution and decisive practice. Accurate anatomical knowlege is frequently required to detect the presence of this disease at that period at which alone the milder process of reduction is practicable; and still more is the combination of skill and intelligence necessary to enable the surgeon to meet all the occurrences which may happen, when the use of the knife becomes the only method of saving the patient.'

In the work before us, Mr. Cooper professes to give an anatomical description of inguinal hernia in its successive stages, and of the parts that lie contiguous to it; and afterward to point out the method of performing the operation in the different varieties of the disease. It may be asserted that no person can be better qualified for the undertaking than Mr. Cooper, as well from his acknowleged talents and skill, as from the opportunities of observation which he possesses, in conquence of his situation in one of the most extensive hospitals of the metropolis.

Chapter I. contains a description of the different kinds of herniæ, and more particularly of those which take place from the abdominal ring, to which the attention of the author is afterward exclusively directed. He points out the manner in which the disease is originally formed, and its connections. with the surrounding parts; minutely describing the state of the hernial sac in its different varieties, and the appearance of the bodies which form its external covering. In the 2d chapter, we have an accurate and perspicuous account of the parts concerned in inguinal hernie. The manner in which the tendons of the abdominal muscles, and the fasciæ connected with them, constitute the abdominal ring and the crucial arch, is particularly stated; together with the passage through which the spermatic chord proceeds from the abdomen to the ring, the peculiar conformation of which, though not altogether a discovery on the part of Mr. Cooper, has been so little noticed by former

former anatomists that they have afforded a very imperfect idea of the structure of the parts, and have led to an erroneous and defective practice.

In chapter III. the formation of hernia is described, and the diagnostic symptoms are pointed out which distinguish it from other diseases of the part. The circumstances which most clearly indicate the presence of inguinal hernia are the following:

First, when the patient is desired to cough, the tumour becomes immediately distended, owing to the pressure of the abdominal muscles forcing down into the sac more of the viscera or their contents. Secondly, when the patient can state from his remembrance that, on the first appearance of the tumour in the groin, it had used to return into the abdomen when he was in a horizontal posture, and to re-appear on standing erect; though circumstances may have long prevented this symptom from continuing.-Thirdly, when the progress of the tumour has been from the groin gradually downwards to the scrotum. Fourthly, when the tumour contains intestine, it is elastic and uniform to the touch; and on being pushed up into the abdomen, it returns with a guggling noise. But when omentum is contained, the tumour is less equal on its surface, receives an impression from the fingers, is heavier than in the former case, and does not make the same noise when returned into the abdomen. Most commonly, however, both intestine and omentum are the contents of the hernia, a circumstance which impairs the accuracy of any very nice distinctions by the touch: though still on pushing back the contents of the tumour, the presence of intestine, which returns the first, will often be indicated by the guggling noise, while the more solid' omentum may be feit going up after it. Lastly, the functions of the viscera are somewhat interrupted. Eructations, sickness, constipation, colicky pains, and distension of the abdomen, occur; and pain is produced by violent exertions, coughing, or sneezing. These are the symptoms that generally give the patient some suspicion of the nature of the com. plaint.'

These diagnostics sufficiently distinguish the disease from many others which, on a cursory inspection, scem to resemble it: but in some cases the symptoms are more obscure; and when the different affections become complicated with each. other, a circumstance by no means of rare occurrence, the practitioner has occasion to exercise his nicest powers of dis

cernment.

Chapter IV. treats of the causes of hernia. These are resolved into two kinds, those which diminish the resistance of the abdominal muscles, and those which increase the pres sure of the viscera; in all cases, the principal pre-disposing cause is weakness. Mr. Cooper enumerates a number of circumstances which most frequently induce this disease, all of REV. JAN. 1807.

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which operate in one of the ways stated above. Among others, he mentions external heat; and in confirmation of this opinion, he remarks that hernia has been observed by different travellers to be unusually frequent in hot climates. We doubt, however, whether there be sufficient evidence of the fact; and we think that the disgusting spectacles, which have been seen in those countries, rather prove the ignorance of the inhabitants respecting the method of treating the disease, or their inattention to such objects of wretchedness. Its frequency in England is much greater than any one would imagine from such a view of the inhabitants as could be obtained by merely passing through the country; and Mr. Cooper himself informs us that, in examining the bodies of old men, he has seldom found them entirely free from it.

According to the condition in which they exist, herniæ are divided into reducible, irreducible, and strangulated; and the 5th chapter treats on the first of these species. This subject gives rise to some practical remarks on the employment of trusses, in which the author has occasion to turn to a valuable purpose his observation respecting the form of the passage through which the spermatic chord descends to the ring. The pad of the truss is generally applied over the abdominal ring itself: but, in order to prevent the future descent of the intestine, it ought to press on the aperture where it first leaves the abdomen. Irreducible hernia is a less manageable complaint: but its increase may be prevented by the use of a bag truss; and by the gentle pressure which this application affords, a gradual absorption of the adipose matter is sometimes effected, and the tumour becomes at length capable of reduction.In the 7th chapter, we have an account of strangulated hernia, and a detail of the symptoms which attend this formidable complaint. The author remarks that the inflammation is caused, not, as in most instances of inflammation, by an increased afflux of arterial blood, but by an obstacle being opposed to the return of the blood by the veins. For this reason, the strangulated part of the intestine assumes a dark hue, even in the early stage of the complaint, which to an inexperienced eye might suggest the idea that mortification of the part had already ensued. The stricture does not, as is commonly imagined, always exist at the ring, but may take place at the aperture mentioned above, where the intestine first leaves the abdomen; and Mr. Cooper observes that it is only when existing in this situation, that it can be affected by spasm: the ring, being composed altogether of tendinous substance, is not capable of this action.

Chapter VIII, on the treatment of strangulated hernia, is

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one of the most valuable in the work; abounding with mi nute practical observations, the result of sound judgment, directed by ample experience. The means on which Mr. Cooper chiefly depends, for the reduction of the hernia, are the tobacco glister, and the application of ice. These remedies, however, too frequently fail of the desired effect, and a surgical operation is then the only resource: which, although generally regarded as of the most formidable nature, is represented by Mr. C. as by no means necessarily hazardous, but to derive its chief danger from being too long deferred. Whenever, therefore, the means for reducing hernia have been unsuccessfully adopted, the knife should be used without farther delay. Unfortunately, we know not any criterion by which the practitioner can determine the exact state of the diseased parts: but the author apprehends that, when the abdomen. becomes tender and painful on pressure, we have reason to fear an inflammation of the peritoneal cavity, and consequently must augur unfavorably of the event.

In the 10th chapter, the operation itself is described. Mr. Cooper advises that the abdominal ring should be divided on the outside of the sac, and that the incision should be made directly upwards, in preference to the usual method of upwards and outwards; since by this means we are certain of not injuring the epigastric artery, however it be situated with respect to the hernia. When, on opening the sac, the intestine is found to be in a gangrened state, critical as must be the situation of the patient, the case is not absolutely lost :-besides the chance of his existing with an artificial opening in the groin, (a state however, of great wretchedness, and indeed almost more to be deplored than death itself,) it is possible to restore the natural condition of the parts, by cutting out the mortified portion of the intestine, and stitching together the ends, which will sometimes unite without much difficulty. Mr. C. gives an interesting account of some experiments performed on the intestines of dogs by Mr. Thomson of Edinburgh; whence it would appear that a transverse division of them is an operation from which they quickly recover, without any extraordinary symptoms of danger being produced; while a longitudinal wound was attended with much more serious consequences.

Chapter XII. gives some practical directions for the management of the patient after the return of the protruded parts. The author is decided in his opinion that all attempts at performing a radical cure, by either cutting away or tying the sac, are not only useless but dangerous. The patient will, indeed, be more liable to the descent of the intestine than he was

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