the romantic regions of Switzerland, and the extensive tracts of Ger many; but on account of the late war, I could not then enter France.

My drawings, and the descriptions of them, which were made during these travels, till upwards of fifty-two thousand pages, and are contained in one hundred and fifty folio volumes, all the work of my own hands; and these labours obtained me the honour of being elected a member of the Royal and Antiquarian Societies of London. My friends have insisted upon my making the public acquainted with my researches, and, previous to my leaving England, I had devoted some time to a selection of the most interesting parts, which I was preparing for the press. that state they now await my return, when I hope to complete the arduous undertaking.'

In

In this wish we cordially unite, and do not wonder that such a statement had its effect upon the National Institute.

We have already devoted so many pages to this pleasing work, that we cannot accompany Mr. F. in his route through Normandy and Morlaix; we can only observe, that he sailed from this port in a Danish merchantman on the 26th of July, 1804, and on the next day landed at Dartmouth.

• My sensations on this occasion no language can describe; but most sensibly did I feel the truth of Mr. Sheridan's assertion, that Buonaparte is an instrument employed by Providence to attach the English more and more to their constitution and liberty; and that whoever treads on British ground, after leaving France, feels as if he had escaped from a dungeon, and was restored to light and to freedom.'

The Appendix contains some letters from Verdun, addressed to Mr. Forbes since his liberation; one of which records a singular triumph of honour in an Irish Gentleman, who refused to accept liberty for himself, his sister, and his mother, when he found that it was offered through the influence of the infamous O'Connor.

We take leave of these elegant and entertaining volumes, with our thanks to Mr. F. for the pleasure he has afforded us, and our hearty congratulations on his return to a land of peace and security.

Art. III. A Treatise on the Process employed by Nature in suppressing the Hemorrhage from divided and punctuated Arteries; and on the Use of the Ligature; concluding with Observations on Secondary Hemorrhage: the Whole deduced from an extensive Series of Experiments, and illustrated by Fifteen Plates. By J. F. D. Jones, M. D. Member of the Royal College of Surgeons of London 8vo. pp. 237. Price 10s. 6d. Philips, London; Guthrie and Tait, Edinburgh. 1805.

THE

HE examination of many works on medicine and surgery, would be inconsistent with our plan; but some treatises on the healing art contain such positions as can hardly be too much investigated, and such practical rules as cannot be too generally

known. Of this kind is the work now before us, and we hope that we shall render essential service to our readers in general by examining its contents. The subjects discussed in this performance,

"Whether we consider them in reference to the patient, or the surgeon, are inferior to none in the interest which they ought to excite. The brave, the unfortunate, and the diseased, are those who plead for that aid which is to rescue them from instant danger. The surgeon never suffers greater anxiety, than when he is called upon to suppress a violent hemorrhage; and on no occasion is the reputation of his art so much at stake. There are only two modes by which we are enabled to obtain any knowledge on these subjects: first, by patient observations made on the human body; and secondly, by direct experiments on brutes. War, accidents, and disease, have never been wanting, and yet the records of our profession afford us but few and detached observations on the suppression of hemorrhage, if we contrast the knowledge we possess with the impor tance of the subject." pp. 7, 8.

The frequent occurrence of wounds, and the dangerous consequences which the slightest might occasion, must render it obvious, that no opportunity should be lost of spreading, as widely as pos sible, such information as may furnish the most rational means of relief. Independently of the great benefits which must result to professional men, from a fair and sensible investigation of a subject involved in a considerable degree of obscurity, it is highly desirable to rescue the public from the influence of error, and from the propensity to employ inefficacious nostrums.

Cases

often occur in which life may depend on immediate and judicious exertions, and a useless remedy, that loses a few minutes, is a fatal aggravation of the mischief.

The first attempt to point out the means which the constitution of our frame employs for the suppression of hemorrhage, was that of Mons. Petit, in 1731. This ingenious surgeon was of opinion, that hemorrhage, from a divided artery, is stopped by the formation of a coagulum, or clot of blood, partly within, and partly without the vessel. He therefore was led to recommend compression, that the clot might not be removed by the impulse of the blood. In 1736, Mons. Morand, who did not deny that the coagulum had some effect in restraining hemorrhage, contended, that the most essential changes which took place, were in the artery itself; the circular fibres corrugating, and thereby shortening, the longitudinal fibres, by which a thickening of the artery, and, in the end, an obliteration of the cavity, he supposed, took place. M. Morand, as appears even from the terms he einployed, had no very accurate ideas of the structure and action of the arteries: his doctrine was, however, soon after adopted by Mr.. Sharpe, in the second edition of his Operations of Surgery. To this opinion succeeded that of Mons. Pouteau, who. attributing VOL. III.

Kk

little or no effect to the clot of blood, or to the retraction of the artery, conceived that the flow of blood becomes impeded, principally by the tumefaction of the cellular membrane, at the circumference of the cut extremity of the artery. Our countrymen, Kirkland, White, Gooch, and Aikin, have adopted the opinion, that the stoppage of the hemorrhage depends on the contraction of the arteries, and not on the formation of a coagulum. Mr. Kirkland made several ingenious experiments, from whence it appeared, that a perpendicular pressure, for a few minutes, upon the end of the vessel, would effectually suppress a hemorrhage from a considerable artery; the pulsation at the extremity becoming less and soon ceasing, the artery collapsing, and gradually closing itself, up to the nearest lateral branches, through which the blood then passes. The last opinion which has been delivered, is that of Mr. J. Bell, who supposes that the spontaneous stopping of hemorrhage proceeds, neither from the retraction of the artery, the construction of its fibres, nor the formation of a clot, but from the injection with blood of the cellular substance, which surrounds the artery.

Thus far had the experiments and observations of preceding anatomists and surgeons advanced our knowledge on this subject. But nothing had appeared to illustrate and reconcile contradictory appearances, or to determine which theory was erected on the firmest foundation. Every one had been most influenced by those phenomena which had occurred in his own experiments; and hence an unjustifiable propensity had been indulged in, to assign the whole effect produced to one circumstance alone. Aware of this, and convinced that a connected series of experiments and of observations could alone furnish satisfactory information on this interesting subject, the ingenious author of this treatise instituted a course of experiments, from the first series of which, nineteen in number, made on arteries which were completely divided, he deduces the following interesting observations.

"These experiments," he says, "shew that the blood, the action and even the structure of arteries, their sheath, and the cellular substance connecting them with it-in short, that all the parts concerned in or affected by hemorrhage, contribute to arrest its fatal progress, by operating, in the case of a divided artery of moderate size, in the following manner.

66

An impetuous flow of blood, a sudden and forcible retraction of the artery within its sheath, and a slight contraction of its extremity, are the immediate and almost simultaneous effects of its division. The natural impulse, however, with which the blood is driven on, in some measure counteracts the retraction, and resists the contraction of the artery. The blood is effused into the cellular substance between the artery and its sheath, and passing through that canal of the sheath which had been formed by the retraction of the artery, flows freely externally, or is extravasated into the surrounding cellular membrane, in proportion to the open or confined state of the external wound. The retracting artery leaves the

internal surface of the sheath uneven by lacerating or stretching the cellular fibres that connected them. These fibres entangle the blood as it flows, and thus the foundation is laid for the formation of a coagulum at the mouth of the artery, and which appears to be completed by the blood, as it passes through this canal of the sheath, gradually adhering and coagulating around its internal surface, till it completely fills it up from the circumference to the centre.

"A certain degree of obstruction to the hemorrhage, which results from the effusion of blood into the surrounding cellular membrane, and between the artery and its sheath, but particularly the diminished force and velocity of the circulation, occasioned by the hemorrhage, and the speedy coagulation of the blood, which is a well known consequence of such diminished action of the vascular system, most essentially contribute to the accomplishment of this important and desirable effect.

"A coagulum then, formed at the mouth of the artery, and within its sheath, and which I have distinguished in the experiments by the name of the external coagulum, presents the first complete barrier to the effusion of blood. This coagulum, viewed externally, appears like a continuation of the artery, but on cutting open the artery, its termination can be distinctly seen with the coagulum completely shutting up its mouth, and inclosed in its sheath.

"The mouth of the artery being no longer pervious, nor a collateral branch very near it, the blood just within it is at rest, coagulates, and forms, in general, a slender conical coagulum, which neither fills up the canal of the artery, nor adheres to its sides, except by a small portion of the circumference of its base, which lies near the extremity of the vessel. This coagulum is distinct from the former, and I have called it the internal coagulum.

"In the mean time the cut extremity of the artery inflames, and the vasa vasorum pour out lymph, which is prevented from escaping by the external coagulum. This lymph fills up the extremity of the artery, is situated between the internal and external coagula of blood, is somewhat intermingled with them, or adheres to them, and is firmly united all round to the internal coat of the artery.

"The permanent suppression of the hemorrhage chiefly depends on this coagulum of lymph; but while it is forming within, the extremity of the artery is farther secured by a gradual contraction which it undergoes, and by an effusion of lymph between its tunics, and into the cellular membrane surrounding it; in consequence of which these parts become thickened, and so completely incorporated with each other, that it is impossible to distinguish one from the other: thus, not only is the canal of the artery obliterated, but its extremity also is completely effaced, and blended with the surrounding parts." pp. 53-56.

The more particular elucidation of these observations, and the remarks on their accordance or disagreement with the observations of preceding writers, we are reluctantly prevented from introducing here; we shall therefore proceed to notice Dr. Jones's farther labours.

Sixteen experiments are related, which were made to ascertain the means which nature employs for suppressing the hemorrhage

from punctured or partially divided arteries. From these it appears, that the hemorrhage was at first stopped in these cases, by a thick lamina of coagulated blood, which, though somewhat thicker at the wounded part, was continuous with the blood lying between the artery and its sheath; and that the arteries being wounded, only to a moderate extent, are capable of re-uniting and healing so completely, that after a certain time the cicatrix is not discoverable on either the internal or the external surface. In this part of the work, Dr. Jones offers some very useful sug gestions respecting the formation of aneurisins, and the treatment of a wounded artery; concluding, however, that in every case in which it can be done, it is best to tie the artery above and below the wounded part, and to divide it completely between the ligatures, agreeable to the practice which was recommended by Celsus.

The author proceeds in the next place to examine the immediate effects produced by a ligature on an artery. His inquiries on this point were very much aided by the information he obtained from Mr. J. Thomson, of Edinburgh, that in every instance in which a ligature is applied around an artery, without including the surrounding parts, the internal coat of the artery is torn by it: a fact indeed which was first noticed by Mons. Dessault.

The structure of the arteries explains on what this curious circumstance depends. Whilst the internal and middle coats are so weak, in their circular direction, as to be very easily torn by any force applied in that direction, the external coat possesses a considerable degree of uniform density. Hence if an artery be surrounded by a tight ligature, its middle and internal coats will be as completely divided by it as they can by a knife, whilst the ex

ternal coat remains entire.

Six very important experiments are here related, from which it appears that a single ligature or more being applied round an artery, even the carotid, sufficiently tight to cut the internal and middle coats, and then directly removed, an effusion of lymph takes place, not only externally, but within the artery, to fill up and obstruct it in such a manner, as must effectually accomplish the obliteration of its canal to the first collateral branches, above and below the obstructed part. If, as Dr. Jones observes, it be possible to produce obstruction in the canal of an artery in the human subject, in the above-mentioned manner, may it not be advantageously employed in the cure of aneurism? inas much as nothing more need be done to prevent the immediate union of the external wound.

In the observations which follow on the process of adhesion, and the changes which an artery finally undergoes, in consequence of the application of ligature, as well as those on the im proper form and application of the ligature, as tending to produce