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•Sudorifics, opium, baths, blisters, astringents, and enemata : with respect to these medicines, as means of cure, I possess little confidence. In most cases, however, I have recourse to them, from the temporary relief which they afford. The subjoined return will show the result of my practice in dysentery for nearly eight months, in Kandy, namely, from the 3d April to the 13th November 1820. A few of the cases, included in the return, had previously suffered under dysentery at Trincomale. Most of the cases were, however, primary attaeks of the disease.
6.'" 185. This return, Mr. Marshall allows, exhibits a smaller ratio of mortality tban usually occurs among Europeans attacked with dysentery in Ceylon; and we humbly conceive that such facts should have induced both him and the Inspector of Hospitals, to give trial to a measure which has been recommended by such able observers in other parts of the tropics, in both hemispheres.
The remaining short Chapters, on Tetanus, Berriberri, Cholera, and Ulcers, present nothing particularly interesting to European readers, and, therefore, we shall pass them over. Upon the whole, Mr. Marshall's work, though it somewhat disappointed us in certain parts, is creditable to his talents as an observant and intelligent surgeon. We recommend the work to every young surgeon about to embark for our East Indian possessions.
IV. Essays on Surgery and Midwifery; with Practical Obser
vations, and Select Cases. By JAMES BARLOW, Surgeon.
One Volume, 8vo. pp. 417. Perhaps as daring and difficult operations in surgery were performed thirty years ago as now; but they are, at present, frequently performed in country towns and even villages, where they would not have been dreamt of half, or even a quarter of, a century ago. Medical and surgical science is tberefore rapidly diffusing itself among, what have been termed, the lower orders of the profession, and this, we conceive, is a matter of far greater importance to society at large, than brilliant discoveries in knowledge, when that knowledge is confined in its practical application, to limited circles, or large cities. The provincial press has, of late years, exhibited unquestionable proofs of the respectable state of medi
cine and surgery in the country, and we are disposed to think, that few surgeons in this proud metropolis would dislike to be considered the author of the work now open before us, though printed and composed in the humble town of Blackburn, in Lancashire. Mr. Barlow appears to be an old, an able, and an experienced practitioner, combining the ardent zeal of youth with the cautious judgment of age—baving been long in the habit of attending, not only to the practical rules which experience and observation have supplied, but to the principles involved in their application and established by their success. Nothing can be more true, than that “the more the efforts of a practitioner, in surgery, (and he might add, in medicine,) are directed by an accurate knowledge of physiology and anatomy (morbid as well as simple,) in their varied and interesting details, the greater will be the certainty of eventual and permanent respectability and success." We have often, as well as Mr. Barlow, had occasion to deplore the too frequent neglect of those pursuits which connect the attainment of skill with the study of science; but, with him also, we rejoice that the diffusion of knowledge, and the enactments of the Legislature, have now secured an increasing attention to every branch of professional information.
The volume before us embraces two very different and distinct subjects-lithotomy and midwifery. It is to the first of these only, that we shall direct our attention in the present article, reserving the latter for our next number.
1. The subject of lithotomy is preceded by some useful preliminary observations on certain disorders of the urinary organs connected with stone in the bladder, which we must not pass over unnoticed. Mr. B. justly remarks, that the anatomy, physiology, and morbid sympathies of the pelvic viscera, should be carefully studied by the operative, and also the medical surgeon. We all know that there is a progressive evolution which marks the range of human existence, and appears to govern the order in which diseases assail the different organs and structures of the body. The prostate gland and neck of the bladder, from their vascular texture and situation, are much exposed to disorder, as life advances. Among the principal causes, we may enumerate high living, constipation of the bowels, and excessive venery. These excite undue vascular action of the parts, and the prostate gland enlarges, partially blocking up, as it were, the orifice of the bladder, so that the urine seldom gets completely evacuated, and a sediment is left behind. Where a predisposition to form calculus exists, portions of gravel, which pass the ure. ters, are retained in the cavity of this receptacle till a nucleus is formed, and a stone, too large to pass the urethra, may Vol. III, No. 9.
thus be produced. Retention of urine, under such circumstances, is not unusual, and the aid of the catheter becomes necessary. The symptoms of diseased prostate and calculi are so associated, that no diagnostic can be formed without an actual examination, eitber by the finger passed up the rectum, or by sounding the bladder. In cases where there was much pain or irritation in the bladder from the presence of calculi, or morbid affection of its coats, accompanied with irresistible efforts to micturate, and pain in the glans penis, or neck of the bladder, our author has found much benefit from injections, into the bladder, of solutions of opium and belladonna in mucilage of acacia, diluted with tepid water. We wonder that this measure is not more frequently resorted to, were it only to allay the acrid stimulating property of the urine, which acts so detrimentally on the too irritable lining of the bladder. Sometimes the introduction of a bougie is useful, in lessening this morbid irritability. In not a few instances, the prostate gland is invaded with irregular swelling, increasing the prostatic curve of the urethra, and thus distorting the passage, so as to cause permanent retention of urine. Sometimes, our author has succeeded, in such cases, by employing a catheter less curved than ordinary-on other occasions, more bent, assisted by the finger in the rectum. Active inflanimation of the prostate gland is another perplexing cause of retention. In these cases, the tender vessels of the urethra become so surcharged with blood that, on every attempt to introduce the catheter, the eyes of the instrument get blocked up, and no urine can pass.
“ To obviate any obstruction in the catheter, I usually plug up the
eyes of the instrument with wax before its introduction, and when the point has reached the fundus vesicæ, I withdraw the stillet, and if the wax does not dissolve by the heat of the part in due time, I then place my mouth to the
open end, and by blowing forcibly through the tube, the wax will be forced out, and the urine pass off without further interruption. In other cases, where the eyes of the catheter have not been previously plugged, and where the urine does not pass voluntarily, I adopt the same expedient, and generally with the same success. 16.
In most cases of diseased prostate, or bladder-affections with retention, our author has been in the habit of keeping the flexible pewter catheter in the bladder, “ by passing the instrument in the usual way, and then introducing a finger up the rectum, pushing it upwards, so that the concave part, near the point, will hook behind the os pubis, and remain permanently fixed.” It should be removed and cleaned, of course, once in six or eight days.
In over-distention of the bladder, and loss of power in its muscular fibres, of some days duration, the catheter becomes an uncertain remedy, as the ureters and kidneys sometimes participate in the state of the bladder, their valvular apparatus becoming changed, and the secretory function suppresed. Mr. Barlow thinks that, if a dribbling of urine did not take place, the bladder would more frequently fall into gangrene than we find to be the case. Early and prompt attention on the part of the practitioner is necessary on such occasions, to prevent vesical and abdominal inflammation. If the bladder ulcerates towards the abdomen, the case is lost—but when the constitutional symptoms are not very grave, and the bladder gives way below that portion of the organ, wbich is screened by the peritoneum," the surgeon should immediately proceed to make a dependant opening into the cellular membrane, where the extravasated urine is lodged, and evacuate the fluid; and to promote the healing of the wound of the bladder, a catheter should be kept constantly in the passage of the urethra, lest a fresh supply of urine from the ureters be accumulated in the cavity, and prevent the process of cure."
These cases require strict attention to the antipblogistic course, besides mechanical aid. Bleeding, local or general, is necessary where there are pyrexial symptoms. The bowels should be emptied by brisk cathartics; and, if there exist much pain and irritation about the neck of the bladder, the tepid bath, and leeches are useful. A combination of the extract of conium, hyoscyamus, colocynth, and blue pill, may be given every night and morning, with effervescing draughts, antimonials, and digitalis, in the day. Our author has experienced great benefit, in such cases, from alternately injecting large portions of warm and cold water up the rectum. But we dare not dwell any longer on the judicious practical observations contained in these preliminaries.
The next subject discussed by Mr. Barlow, is the symptomatology of stone in the bladder, together with the method of sounding. This section, however, we must pass over, though containing much sound remark. Our author then gives a succinct account of the different modes of operating for the stone, beginning with the Celsian, or apparatus minor, and ending with that by the knife alone. On each method, our author makes some remarks of his own. The Celsian operation, or “ cutting on the gripe,” Mr. Barlow is induced to think, by no means
an uneligible operation, when confined to young subjects. “ The method is simple, and less burthened with instruments than any other plan of operation by the lateral passage, and greatly resembles the mode adopted by Cheselden and Raw." Celsus appears to have been well aware of the danger attending a small wound, and the retention of urine, which sometimes succeeds an operation.
“ Proximo die,” says he, “ si spiritus difficilius redditur, si urina non excedit, si locus circa pubem mature intumuit, scire licet, in ves ica sanguinem concretum remansisse. Igitur, demissis eodum modo digitis, leniter pertractanda vesica est, et discutienda, si qua coierant: quo sit, ut per vulnus postea procedant.” 69.
He recommends the stone to be broken, if too large, a practice invented by Ammonius, about 150 years subsequent to Hippocrates, and thence called lithotomy, or stone-cutting. *
Passing over the apparatus major and those“ horrid instruments called dilators," our author comes to the high operation, lately revived in this country. He properly observes, that as this operation has, for a long time, been abandoned, we can only judge of its success, from the records of those times in which it was in repute, compared with the present lateral operation.
“ And if I mistake not,” says Mr. B. “ the success attending the High Operation as practised both by the English and French sur
• “Si quando autem is major non videtur, nisi rupta cervice, extrahi posse, findendus est, cujus repertor Ammonius, ob id adorouos cognominatus est.”
Cels. lib. vii. p. 44. The writings of Celsus may be considered as exhibiting an epitome of the medical and surgical knowledge of the Antients at the time he wrote. We have always been more surprized at the intrepidity of their surgery, than the depth of their physic. Considering that they were ignorant of the circulation of the blood, we cannot but admire their bravery in extirpating the thyroid gland-at least, Celsus describes the removal of bronchocele by the knife.
“ At in cervice, inter cutem et asperam arteriam, tumor increscit (bronchocele Græci vocant) quo, modo caro hebes, modo humor aliquis, melle aquæve similis, includitum. ***Potest autem adurentibus medicamentis curari. **Sed scalpelli curatio brevior est. Medio tumore una linea inciditur usque ad tunicam: deinde vitiosus sinus ab integro corpore digito separatur, totusque cum velamento suo eximitur."
Lib. vii. Sec. 13. It is very remarkable, that the Antients should have been in the habit of using the ligature to vessels that were divided in wounds, and yet that they, and we may say the Moderns, till comparatively of late, should never have thought of tying the vessels in amputation. That the ligature was familiar to Celsus, is proved by the following passage. After describing various styptics for stopping hæmorrhage from wounds, he goes on to say :
“ Quod si illa quoque profluvio vincuntur, venæ (by which he means all blood-vessels) quæ sanguinem fundunt apprehendendæ, circaque id, quod ictum est, duobus locis deliganda, intercidendæque sunt, ut et in se ipsæ cöeant, et nihilo-minus ora preclusa habeant."-Lib. v. de Vulneribus. Here is the modern operation of tying the artery in two places, and dividing it between the ligatures, in the most clear and unequivocal language. Both the above extracts shew, that Mr. S. Cooper is not justified in saying, (art. Hæmorrhage,) that's the Ancients, ignorant how to stop bleeding, were afraid to cut out the most trivial tumour.''-Dict. 3d Ed. p. 518.