Reviews and Notices of Books
1895
The Lancet
an enormous strangulated umbilical hernia. There was a spot of gangrene the size of a shilling on the upper part of the tumour. The pulse was quick and the patient's general condition was such as to render any operative interference extremely unpromising. However, the sac was opened and was found to contain the greater part of the omentum and of the transverse colon, the latter being gangrenous. In addition, there were some coils of small intestine easily reducible. The whole of the gangrenous
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... ut was cut away, and the ends were united with Murphy's button. The omentum, sac, and skin (a huge mass) were then removed and the wound closed. The patient died eight hours after the operation. A post-mortem examination showed that there had been no bleeding and that the button was in good position. CASE 5.-A woman aged forty-three years was admitted on June 23rd with a large irreducible umbilical hernia, which was operated upon on the 24th. In this case the umbilical opening was closed transversely with buried sutures of silkworm gut and the skin wound in the same direction with silkworm gut. No drainage was employed and the wound closed satisfactorily. The progress of the case was interrupted by the formation of an ischio-rectal abscess, and the patient was not discharged till Aug. 10th, when she left the infirmary quite well, suffering no inconvenience from the buried sutures. Remarks by Mr. PAGE.-Before the days of antiseptic surgery an operation for radical cure would have been looked upon in all the above cases as out of the question. There would have been no chance of success. In the fourth case something had to be done, and I quite believe, had the operation which was performed been done earlier, it might have been successful. Great pains were taken before and at the time of operation to render the whole surface of the abdomen aseptic, a solution of bichloride of mercury being the germicide ! , employed for the purpose. After the final cleansing of the skin no chemical was employed, boiled water only being used for washing and flushing the wound. This is the usual practice in my wards, and union by first intention is the rule. As to the prospect of permanent cure in these cases of large umbilical hernia, I think it is very good. Speaking from a considerable experience, I consider the prospect of permanent cure to be as good as, if not better than, in the very large inguinal herniæ. The opening in the very largest umbilical hernia is seldom more than three inches in diameter, and generally it is less, nothing in comparison with the wound made for the removal of a uterine fibroid or solid tumour of the ovary. Swan Sonnenschein and Co. 1895. pp. 591. THE object the author has in view in this work is to show that whilst there is strong evidence in favour of organic evolution, natural selection has no place in nature. Natural selection is based on the analogy believed to exist between the process of artificial selection and a process supposed to take place in nature. In the latter case the struggle for existence is said to be the selecting power, and it acts by securing the survival of the fittest. This is accomplished by a process of selection from those variations, however small, which are necessarily associated with sexual reproduction, leading by degrees to the transmutation of species. In opposition to this the author believes that if such a selective action did exist, other factors of evolution would anticipate its action in the transmutation of species now going on, and, further, that there is no definite proof of its action in the earlier stages of organic evolution. In his discussion of the subject Mr. Coe submits the theory of the transmutation of species by means of natural selection to certain tests, and asks, in the first place, whether there is a general consensus amongst scientific men in regard to the precise meaning of the term natural selection, since some hold that organisms are constantly varying in all directions, whilst others think that they vary only from a central line, from which a few variants diverge on either side; and some again maintain that they vary to a considerable, others to only a slight, extent. These variants are no doubt due to certain as yet unknown causes, but their preservation is due, Mr. Coe appears to think, to chance. Now, in the vast proportion of instances any variation is swallowed up and extinguished in what Mr. Francis Galton terms the regression to mediocrity. Hence, if a new and permanent variety, which is a step towards a new species, is to arise, some special modification should appear simultaneously in many individuals in a certain area. Romanes thought there was no warrant for this; Wallace, however, with far larger experience, holds that there is good reason for accepting it. Mr. Coe takes exception to the term natural selection, and shows that in reality two events are included under this term-viz., the survival of the fittest alone and the survival of the fittest and some not the fittest, and considers that these two things require differentiation. He notes also that the degree and constancy of the struggle for existence are estimated differently by different observers. He makes a good point of the alternative use of the terms " natural selection " and " survival of the fittest " as used by Wallace and Darwin, so that when a difficulty presents itself one or the other term may be employed, as may be most convenient. The argument advanced in favour of the struggle for existence is discussed at some lengthviz., that since animals increase in geometrical ratio, any one animal or plant, if unchecked, would speedily overrun the world, and he meets it with the objection that for this to occur so large a series of other " ifs " must be admitted in regard to soil, climate, and other conditions as to render such multiplication almost impossible, and he holds that the output of life has been greatly over-estimated. On the other hand, he brings evidence which casts a doubt upon the constancy and severity of the struggle for existence between animals and plants of nearly allied or identical species, and shows s that such competition is largely modified by the cooperation which so frequently obtains amongst the members of the animal world. He further maintains that the circumstance of one plant or one animal displacing another-as, for example, the brown Norwegian rat exterminating the black English rat or the willow displacing the watercress in the New Zealand riversalthough it may be employed as an argument for the struggle for existence and for the selection of favoured species, yet it by no means proves natural selection or the transmutation of a species by the selection of favourable variations which arise in connexion with sexual reproduction. He lays great stress upon the differences that exist between artificial and natural selection, the process in the former being strictly controlled by man with some definite object or objects in view, as beauty, strength, fleetness, or mere monstrosity; whilst in nature not only is there mergence of special characters in the general type, but death is apt to supervene and prevent the perpetuation of the special form or type that may have appeared-" the principle of Utility dominates Natural Selection with an iron rule "and he thinks Mr. Romanes' assertion rash, that the death which takes place in nature must act with so much greater vigilance than is exhibited by the cattle breeder or the pigeon fancier, "for this death is often indiscriminate, the conditions under which the test is applied are often such that it would be rash to say whether the survivors were the fittest or the most fortunate." The only answer to this criticism, which is sound enough, is that the time is infinite, and the number of generations enormous, whilst now and again exceptional circumstances may occur favouring the preservation of life, as, for example, the comparative absence of enemies to the rabbits in Australia, where a favourable form might arise and be perpetuated. On the other hand, such chance would be greatly diminished in a region
doi:10.1016/s0140-6736(00)31717-2
fatcat:tyk52tg2erhbhdlrz4g6cy7n2q