forceps are taken between the thumb and fore finger of the right hand, and if the iris is not protruding through the wound (prolapse), they are passed into the anterior chamber, and the iris seized near the pupillary margin and withdrawn a little outside the lips of the wound. The forceps, still holding the iris, are now very carefully changed from the right to the left hand, and the scissors taken in the right, with which, the projecting portion of the iris must be slit up from the free edge (close to the iris forceps) to the ciliary margin within

margin by dragging it upwards to the extreme limit of the scleroti wound where it is also to be made tense and cut off close to the wound. By thus removing the lower division first, any hæmorrhage that might

follow would be less likely to interfere with the removal of the upper division. Fig. 3 represents the shape of the pupil after the segment of the iris has been excised. If there is hæmorrhage into the anterior chamber after the operation, an effort must be made to evacuate it, by making pressure with the forceps or curette upon the posterior lip of the wound. After the eye has been freed from blood, the eyelids must be gently closed

FIG. 3.

and two or three narrow strips of Husband's isingless plaster applied to keep them in apposition. In cases of extensive hæmorrhage into the anterior chamber, Arlt's compressed bandage should be applied. If pain should come on soon after the operation, two or three leeches should be applied to the temple withont delay. The patient must be kept quiet and the eyelids kept closed for about four days.

The beginner will find it much the easiest to perform iridectomy out-wards; the upward exsection is however to be preferred, for the reason that the eyelid afterwards covers the slight deformity and prevents any unpleasant dazzling by shading the upper portion of the enlarged pupil. In performing iridectomy upwards, it is necessary to use an iridectomy

knife that is bent close behind the widest part of the blade; and the assistant must use very great care in rolling the ball downwards.

Mr. Carter, of Stroud, England, performed iridectomy 57 times without any mischance; there are however certain disadvantages that may arise from the operation; under certain circumstances the outbreak of laucoma in the other eye may be accelerated; in some cases the incisions in the sclerotic heals imperfectly ("cystoid cicatrix;") but these are very slight drawbacks when compared to the "inestimable boon which the operation affords."

In confirmation of the views expressed in the foregoing pages in favour of iridectomy, I make the following quotations, with which I must bring this lecture to a close:

"An immediate operation for strangulated hernia can never be more essential to the preservation of life than an immediate iridectomy frequently is to the preservation of eyesight. The time during which it can be usefully performed is often very limited, and the patient whose case requires it has a right to expeet relief at the hands of the nearest practitioner. There can be no doubt, I think, of the correctness of the opinion advanced, a year or more ago, by the Editor of the British Me dical Journal, to the effect that any surgeon who neglected iridectomy' in the presence of certain indications for its performence, would incur great risk of being mulcted in very heavy damages as the defendant in an action for malpractice." (Carter.)

"From the first introduction of iridectomy into England, in 1857, it has proved the source of the greatest blessings to numerous sufferers; and now that the indications for it, and the mode of performing it, are generally understood, there will very shortly, in my opinion, be no excuse for any one, oculist or general surgeon, who shall neglect either to perform it himself in suitable cases, or to pass on his patient to some one who will." (Bowman)

REVIEWS AND NOTICES OF BOOKS.

Chloroform: its Action and Administration. By ARTHUR ERNEST SANSOM, M. B., London, late House Surgeon and Physician-Accoucheur's Assistant to King's College Hospital. 8vo. pp. 279 Philadelphia Lindsay & Blackiston. 1866.

The work before us consists of twenty chapters on the subject of chloroform, its action and administration. Chapters one and two, are

on the discovery of chloroform and the influence of that discovery. The author gives a succinct history of the means adopted, from the very earliest periods, of preventing suffering during surgical operations. The ancient Egyptians employed drugs to produce a state of insensibility; these were chiefly the Cannabis Indica, and the juice of the poppy. The Romans, at the time of the Empire, employed various means to mitigate the pain inflicted by the surgeon's knife. Pliny and Diascorides mention several medicaments given by the stomach to relieve pain. The Chinese of the third century employed inhalations of the fumes of burning hemp, for the purpose of mitigating the horrors of surgical operations. At various periods of the world's history, surgeons have endeavoured to allay pain by the exhibition of narcotics. Sir Humphrey Davy experienced relief in cutting a wisdom tooth by inhaling nitrous oxide gas, and he suggested that it might be used with advantage during surgical operations. In 1844, we find his suggestion adopted by Horace Wells, an American dentist, who extracted teeth, without pain, from parties while under the influence of laughing gas. Subsequently, sulphuric ether was employed by inhalation, and Morton, the dentist, extracted a tooth from a man named Frost, while under the influence of sulphuric ether, absolutely without his knowledge of the operation; this was at Boston, U.S., on the 13th September, 1846. Some delay was occasioned in extending the benefits of this boon to suffering humanity, as Mr. Morton secured patent rights, and did not explain the nature of the substance inhaled.

We remember well this cause celèbre, and shortly after we saw in the Montreal General Hospital the vapour. of ether tried in a case in which amputation of the leg was deemed necessary. About the same period, ether by inhalation was employed by Dr. Douglas at the Quebec Marine and Emigrant Hospital, Dr. Worthington of Sherbrooke, and more extensively in the United States hospitals of New York, Philadelphia, Boston, &c. But the discovery of the properties of chloroform, by Dr. Simpson, completely supplanted ether as an anæsthetic.

Before the discovery of the anesthetic properties of chloroform, the surgeon required nerves of steel to enable him to perform his duty on the shrinking, writhing form before him. In looking back, at the times that are past, we well remember the sensations experienced in witnessing surgical operations performed under the most trying circumstances, when the groans and shrieks of the sufferer sent many a pang of horror to the looker on. We regard the benefits derived by the discovery of anaesthetics as inestimable. The mortality of all operations has been considerably essened; according to the statistics given by one author, they are in

some instances fully one-half. All honour, then, is due to the benevolent men, who, at the risk of their own lives, discovered the anæsthetic property of chloroform.

It was to the persevering energy of Sir J. Y. Simpson, that the world owes this great discovery.

"In March, 1847, Flourens announced to the Academy of Sciences of Paris, certain observations on the anesthetic powers of chloroform upon animals. He considered it dangerous. Meanwhile, Dr. Simpson, of Edinburgh, had experimented on many hydrocarbons, on acetone, nitrous ether, &c., with a view of determining their anæsthetic properties. On the memorable evening of November 4th, 1847, he determined on trying a hitherto discarded, heavy fluid, chloroform.

"Dr. Miller gives a graphic account of this birth of chloroform. Doctors Simpson, Keith, and Duncan sat each with a tumbler in hand, and in the tumbler a napkin. Chloroform was poured upon each napkin, and all patiently inhaled and waited for something to turn up. After a probation, Dr. Simpson, drowsy as he was, became convinced that something had turned up, for he heard Dr. Duncan snoring, and Dr. Keith kicking about in an inelegant manner. All these effects had been manifest in a very short time, and the experimenters (or experimentees) all agreed that chloroform was far more agreeable than ether.

"Hereby, then, Dr. Simpson established an agent far quicker in operation, far more pleasant than ether. Soon afterwards, chloroform was administered to a highland boy, and a diseased portion of the bone of his forearm was removed absolutely without pain."

The next four chapters are on the chemistry of chloroform, the effects of its inhalation, its physiological effects and action on the blood. We next come to "the danger of chloroform;" diseased conditions, which increase that danger, and danger of incautious administration of chloroform; signs of danger, and mode of death.

Chapters twelve and thirteen are devoted to the subject of resuscitation in apparent death from chloroform, and practical details, &c., for producing resuscitation. There are several marked cases which have been recorded in which the patient has been saved by constant and unwearied attempts at reanimation.

"In the first case of resuscitation recorded the pulse had ceased, but artificial respiration restored the patient (Ricord). In a case recorded by Mr. Broadbent, the heart had ceased to beat, the pulse had quite stopped. Artificial respiration and tracheotomy restored the patient. In another case the alarming sign was that the blood issuing from the wound made for the removal of an adenoid tumor of the breast ceased.

The heart had, of course, failed. Artificial respiration was commenced, and at the end of three minutes the pulse began to return; in six or seven minutes there was recovery. A third instance is recorded by Dr. Burge, of New York, Chloroform was given to a young lady for the performance of amputation of the thigh. The respiration ceased, the pulse could not be felt, and the jaw dropped, but artificial respiration restored life. A fourth is recorded by George Wigan, Esq. In a fifth, after respiration, had ceased, the pulse ceased, and all around thought that death had taken place. Trachetomy performed immediately, and artificial respiration, kept up for an hour and a half, restored life. In a sixth case, a girl of six, the pulse ceased-' there was no pulse for a quarter of an hour.' Artificial respiration, kept up for half an hour, restored life. In a seventh, a boy of four, the pulse had quite ceased, the jaw had dropped, and the body had become corpse-like. Artificial respiration, continued by means of Faradization of the diaphragm, restored life."

There is a chapter on methods of administering chloroform, as also one on practical rules to be observed during its administration. The concluding chapters are devoted to the subjects of chloroform in surgery; in obstetric practice; in practical medicine, and in dentistry; and the author fully points out the benefits derived by the employment of this agent. In surgery it has produced a revolution in practice, as it is not alone the saving of shock and pain to the patient, but what is often of greater value to the surgeon, the relaxation of muscles as in cases of dislocation. The author has certainly “supplied a want," and has at the same time given to the medical world a work of great practical merit. We must recommend its perusal to all. It is neatly got up; but we think the illustrations, of which there are some sixteen, might be better executed. To be had of Dawson Bros.

A Manual of the Principles of Surgery, Based on Pathology, for Students. By WILLIAM CANNIFF, M.D., M.R.C.S., England, late Professor of General Pathology and the Principles and Practice of Surgery, University of Victoria College, Toronto, C.W., &c., &c., 8vo. pp. 402. Philadelphia: Lindsay & Blackiston. 1866.

The author informs us that the basis of this work was laid while he was engaged in delivering lectures on the Principles and Practice of Surgery, in connexion with Victoria College, Toronto, C.W. It may be regarded, therefore, as the work of a Canadian author, and although we are not of that class who look for no good thing out of Nazareth, we must say that we cannot commend this book as containing original teaching, the result of extended observation. In fact, the author honestly affirms