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Reviews or notices of several works have been unavoidably postponed.
others, the Provincial Transactions, and Mr. Simpson upon Education, which were pro-
mised for this number, must stand over for our next.

Two of the communications of Dr. Kennedy were too late. One, he will perceive, is
inserted.

Dr. Forsayth was also too late for the present number. His case will appear in our

next.

We are compelled to defer a notice of Mr. Stevenson's operation for cataract. We
lately had the pleasure of seeing him perform it :-the dexterity was great, and we be-
lieve the result has been successful.

On the first of January, 1835, will be published Professor Grant's Outlines of Compara
tive Anatomy, in one volume, 8vo. with upwards one hundred woodcuts from drawings on
wood by Mr. H. J. Townsend, engraved by Branston.

THE

Medico-Chirurgical Review,

No. XLI.

[NO. 1 OF A DECENNIAL SERIES.]

APRIL 1, TO JULY 1, 1834.

PATHOLOGICAL AND SURGICAL OBSERVATIONS ON THE DISEASES OF THE JOINTS. By B. C. Brodie, V.P. R. S. Serjeant-Surgeon to the King, and Surgeon to St. George's Hospital. Third Edition, with Alterations and Additions. Octavo, pp. 344. London, 1834.

THE first edition of this work appeared, we believe, in the year 1818—the second in the year 1822—and the third is now brought before the public. Mr. Brodie informs us, in the preface to this edition, that it is not a mere republication of those which have preceded it. He observes that there are not more than two chapters which appear exactly in their former shape, and some of them are so altered that they bear but little resemblance to their originals.

We are led to offer a complete analysis of this, although an established work, on several accounts; because it is one of the most striking examples in medical literature of inductive reasoning-because the profession do not seem to be as well acquainted as they should be with its doctrines and its facts-and because we have Mr. Brodie's word for the novelty or re-arrangement of considerable portions of it.

We have said that the work is a striking specimen of inductive reasoning. We have heard this advanced as an objection. It has been urged that it displays no ornaments of diction-no grace of fancy; that all is straight and level, and uninteresting as a road in France. It is true that the charm which breathes through the writings of Pott, and the fire which blazes in the pages of John Bell, do not wait on the cautious and exact demonstration of Mr. Brodie. But something more permanently useful is there-the steady pursuit and the sure acquisition of philosophical truth. Those who quarrel with the works of Mr. Brodie, turn with disgust from demonstrative reasoning; consider laborious and patient observation as the drudgery of a sordid mind, rigid deduction as the fetter of a mechanical one. They wear in their soul, if not upon their lips, the sneer of Gibbon at "the patient and sure-footed mule of the Alps." We do not purpose to eulogize nor to defend inductive reasoning, for it needs neither eulogy nor defence. We cannot refrain from deploring the absence of it in the great majority of medical works. The journalist has too frequent occasions of observing how loose and unconnected their texture is, how discreditable to the education and the capacity of the author, how derogatory to the philosophical character of the profession. It would be painful and invidious to adduce examples VOL. XXI. No. 41.

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from the writings of those who are not of the oi woλ, but who have gained the honours and the dignities among us. This reflection leads us to single out the work of Mr. Brodie, and, by laying it fully before our readers, to inculcate its principles, evince our admiration of its execution, and hold up both to the surgical and medical world as a valuable model.

It may seem surprising that only two editions of a work so important should have been consumed in the period of sixteen years. The cause of this will be chiefly found in the prevalent unwillingness of the profession to study works of so grave a character. But we trust that the more complete education, medical and general, that our youth receive, with the wide diffusion of useful knowledge and cultivation of the judgment and the reason, will improve the taste of those who write and of those who read. We hope the profession will not allow twelve years to elapse before they require another edition of Mr. Brodie's treatise. It demands a moderate acquaintance only with surgical authors and with surgical practitioners, to discover that they are either unconscious or careless of the great improvements in pathology and treatment which the treatise in question contains. In recent books we often find the same vague ideas of spina ventosa, and white swelling, and scrofulous joints, which clouded the surgical horizon previous to the publication of Mr. Brodie's researches. In practice we constantly observe a lamentable ignorance in the management and diagnosis of diseases of the joints. Scarce an author appreciates to the due extent Mr. Brodie's labours-scarce a surgeon appears to be perfectly conversant with his practical improvements. Confusion obscures the pages of the one, ignorance directs the hand of the other.

On these accounts, then, we are led to offer a methodical analysis of the present edition of Mr. Brodie's work. Independently of the practical matter it contains, it is calculated to form and to improve the taste of the surgical inquirer. And we feel convinced that so many are unacquainted, or imperfectly acquainted, with what has been effected by the author, that we confer an essential boon upon the public in drawing its attention as forcibly as possible to his facts and his conclusions.*

The work consists of ten chapters, with an appendix principally dedicated to a criticism of the paper published by Mr. Key in the last volume of the Medico-chirurgical Transactions. The subjects considered in those chapters are-Inflammation of the Synovial Membranes of Joints-Ulceration of the Synovial Membrane-a Morbid Alteration of Structure of the Synovial Membrane-Ulceration of the Articular Cartilage-a Scrophulous Disease of the Joints, having its origin in the Cancellous Structure of the BonesCaries of the Spine-Tumors and Loose Cartilages in the Cavities of the Joints-Malignant Diseases of the Joints-some other Diseases of the Joints -Inflammation of the Bursa Mucosa. It must be owned that this enumeration of affections displays an ample field for accuracy of diagnosis, and appropriate application of treatment. We have already stated that our notice will be strictly analytical.

* As this article was written subsequently to the completion of that upon Mr. Wickham's book, some repetitions may be noticed in the one of what the reader may have perused in the last.

In a brief introduction, Mr. Brodie alludes to the reasons which induced him to select for investigation the diseases of the joints. Perhaps the following exercised the greatest weight with himself, and will form a satisfactory apology to the profession.

"They have scarcely met with the attention which they merit from former pathologists. The terms, white swellings, scrophulous joints, &c. have been used without any well-defined meaning, and almost indiscriminately; so that the same name has been frequently applied to different diseases, and the same disease has been distinguished by different appellations. Confusion with respect to diagnosis always gives rise to a corresponding confusion with respect to the employment of remedies; and hence I was induced to hope, that, if it were possible to improve our pathological knowledge of the diseases to which I have alluded, this might lead, not indeed to the discovery of new methods of treatment, but to a more judicious and scientific application of those which are already known, and a conséquent improvement of chirurgical practice." 2.

I. ON INFLAMMATION OF THE SYNOVIAL MEMBRANES OF JOINTS.

Mr. Brodie remarks, that the adipose membrane belonging to the joints may be inflamed, and that the ligaments may be the objects of primary disease. But the malady, in either case, is too rare or too vague to form a subject of distinct consideration. The synovial membrane, like other vascular organs or parts, is frequently diseased. Mr. Brodie considers in order the morbid anatomy, the causes and symptoms, and the treatment of inflamed synovial membrane.

He observes that cases occasionally, though rarely, occur, in which a joint is swollen from a preternatural quantity of fluid collected in its cavity, independently of pain or inflammation. This passive effusion may be compared to hydrocele, and has been not improperly denominated "hydrops articuli," and "hydrarthrus." But usually the swelling is attended with pain and inflammation, and is dependent on increased secretion from the surface of the synovial membrane, occasioned by the latter. In some instances, while there is still pain and inflammation in the joint, the fluid is felt indistinctly, as if a considerable mass of soft substance lay over it. Often, when the inflammation has subsided, and the fluid is no longer to be felt, the joint remains swollen and stiff; painful, when bent or extended beyond a certain point, and liable to a return of inflammation from slight causes.

Omitting the cases whose dissections explain the preceding observations and confirm the following, we pass to their summary expression. Inflammation of the synovial membrane occasions these effects:-1st, a preternatural secretion of synovia; 2dly, effusion of coagulated lymph into the cavity of the joint; 3dly, in other cases, a thickening of the membrane; a conversion of it into a gristly substance; and an effusion of coagulated lymph, and probably of serum, into the cellular texture, by which it is connected to the external parts. In other cases, Mr. Brodie has found reason to believe that the inflammation had produced adhesions, more or less extensive, of the reflected folds of the membrane to each other. He has also observed occasionally, in dissection, such partial adhesions as might reasonably be supposed to have arisen from inflammation at some former period.

In one case related, the cartilage adhered to the bone less firmly than usual at the edge of one of the condyles of the femur. In another, the

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