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cision, where the resistance opposed the greatest obstacle; in this manner sufficient room was made, and the transmission of the stone effected. It was of an oval shape, and its long diameter 2.25, and its short 1.75 inches. A female sound was then passed into the bladder, and another stone detected larger than the first, and which was extracted with proportionate difficulty. It was also oval, but measured 2.6 inches one way, and 2.1 the other. From the different situations in which I had an opportunity of recognizing the prostate gland of this patient, both by the finger passed up the rectum, and through the wound in perineo, its lateral lobes evidently pressed considerably on the rectum, and appeared the shape and size of the gizzard of a goose. Several arteries were divided in the operation, which required the ligature, and there remained a considerable oozing of blood, which appeared to come from the divided edges of the prostate gland: to suppress which a canula, with a piece of sponge wrapped round it, was introduced into the wound, and by its pressure on the incised portions of the gland, prevented the blood from making its way into the bladder, and soon stopped the bleeding." P. 147.
On being put to bed, sixty drops of tincture of opium were given him; but it did not procure sleep. He appeared restless in the evening, with quick pulse; but there was no tension, or hæmorrhage, the water passing gullatim through the canula. He was put into the warm bath for twenty-five minutes, which afforded temporary relief, but did not reduce the pulse. The opiate was repeated-no sleep through the night. A perients, glysters, and the warm bath were exhibited every day for several successive days.
“ On the 20th instant, three days after the operation, a degree of soreness and tension manifested itself in the lower part of the abdomen, which extended along the urethra, ard assumed the appearance of peritoneal inflammation. But on a minute investigation, I was convinced that the tension of the abdomen was caused by the parts of the wound connected with the operation being distended with inflammation, which wholly prevented the evacuation of the bladder, and the voluntary power of the abdominal muscles from propelling the urine through the aperture.* Without hesitation, I
stone be found either of unusual magnitude, or less than what was suspected prior to commencing the operation, the screw of the handle may be elevated or depressed whilst the apex is in the bladder, and the cutting edge regulated to any given extent.”
“ * I am induced to believe, that Ischuria Vesicalis, subsequent to the operation of lithotomy, is not a very rare occurrence, but is frequently the primary cause of Peritoneal Inflammation, though scarce noticed by authors who have written on the after-treatment of patients. As the symptoms at first view bear much analogy to each other, it is incumbent on the surgeon, in every instance of abdominal affection to
passed a female catheter up the wound in perineo into the cavity of the bladder, and evacuated more than a quart of limpid urine, of healthy appearance. This mode of assisting nature in relieving herself, was found necessary to be repeated every eight or ten hours for several succeeding days, until the tension and inflamination of the parts connected with the wound had subsided; after which the urine passed through the artificial aperture with comparative free.dom.' 149.
In about three weeks from the date of the operation a little urine came away at intervals by the urethra, and the man seemed to be recovering, when a new train of symptoms came on, accompanied with inflammation and suppuration of the right testicle, which produced some fever and irritation in the system ; but this was got over; and in ten weeks the patient returned home apparently in good health-the size of the prostate gland, as examined, per reclum, much diminished. It is probable, our author thinks, that, had the gorget been used in this case, it would not have divided more than half of the left portion of the prostate gland, and that consequently the incision must have been quite inadequate to the free extraction of the calculus, and probably too small to admit the blades of the forceps without much violence or even laceration.
For the curious case of lithotomy in a female, complicated with procedentia uteri, procedentia vesicæ, and inversio vagina, we must refer to the volume itself. The operations and management do great credit to the surgeon.
The surgical half of this volume concludes with a case of tumour on the nose, introduced by some ingenious physiological remarks on the analogy between animals and vegetables, as well in regard to their structure and functions, as their diseases. There can be no doubt, iadced, that one common principle of vitality pervades the whole of the animal, vegetable, and perhaps we should not be wrong in including, the mineral kingdom. It is extremely difficult to say where life ceases to exist in any thing we see in air, on carth, or in the ocean. But we will not bewilder ourselves
investigate the state of the bladder, and witness the discharge of urine, either from the wound, or by the urethra. By this mode of enquiry, the morbid retention of urine may be distinguished from abdominal inflammation, and if no urime has passed by either of these apertures, a female catheter should be introduced through the wound into the bladder and the water evacuated, by which means the symptoms will subside, .and by omitting this mode of relief, inflammation of the abdominal viscera and bladder would inevitably follow, and there is reason to believe, that serious effects have sometimes ensued from this species of retention of urine being overlooked.”
in speculations on those subjects which are apparently, or rather really, beyond our reach, wbile so much remains to be learnt that is possible to be accomplished, and useful when acquired. Life is so short, and so great a portion of that life taken up with the necessary functions for which man is destined in this world, that we dcem it imprudent, particularly for medical men, to dedicate more than a very limited portion of time to other than the main objects of their professional researches. *
The subject of the tumour in question, was a respectable sclroolmaster of Blackburn, who consulted our author pecting a morbid rubecund tumour seated on bis nose,' which had been increasing for thirteen years past.
“ The tumour extended from the superior part of the nose over the ale nasi and apex on both sides down to the lower part of the upper lip to such an extent, that the nostrils and mouth were nearly closed, and when laid down to sleep his breathing was greatly obstructed, unless the tumour was supported by a folding of the pillow placed under it; and when attempting to drink, it became in part immersed in the liquid, unless it was raised by the hand.
" At the lower part of the tumour, rather parallel with the septum narium, the cuticular surface of one projecting tubercle was excoriated, from which there was an offensive exudation.” 171.
Our author proposed a total eradication of this disgusting cxcrescence by the knife. Keeping the natural figure of the nosc in his mind, he began the dissection at the superior part of the tumour, as high as the dorsal arch, continuing The incision along the alæ down to the apex on both sides, close to the periosteum and perichondrium, steadily pursuing this project till the whole of the morbid mass was eradicated. The operation did not occupy much time, nor did the patient complain of any pain during the removal of the tumour. The wound was allowed to bleed without interruption, and the bæmorrhage ceased in a few minutes, except from one artery, which required a ligature. The whole surface of the sore was hicaled in three weeks, and no trace of of cicatrix could be observed, unless by a very near inspection. On dissection, this anomalous tumour exhibited a vascular appearance, and assumed a deep red and livid huc, its structure not corresponding in appearance with any distinct species of tumour, which has been described by authors. Mr. Barlow has given two plates, one representing the pa
* We do not mean the search after patients, which some of our brethren, we are sorry to say, consider the “ main objects” of their pursuits.
tient before, and the other after, the operation. The contrast is most striking.
Our readers will bave seen, by this time, that the portion of the volume which we have analyzed does credit to provincial surgery. In our next we shall bring forward some interesting obstetrical information.
V. Observations on those Diseases of Females which are atten
ded by Discharges. Ilustrated by Copper-plates of the Discharges. By CHARLES MANSFIELD CLARKE, Member of the Royal College of Surgeons, London. Part II. 8vo. pp. 242. London, 1821..
[Second Analytical Article, continued from No. 8, p. 778, Vol. II.] To those who have properly considered the nature and objects of this Journal, it will be unnecessary to give any reason why our analyscs are sometimes carried to an unusual length, as compared with similar articles in other periodicals. It is quite out of the question that we can compete with our swiftlooted nionthly cotemporaries, in bringing the earliest samples of medical lore into the literary market. It is the object and office of these avant-couriers to whet the appetites of the reading public—it is ours to lay more substantial fare before them-and to constitute a medium between the ponderous octavo itself, and the multiform critiques that “ spread their light wings,” and waft its condemnation or praises through the medical republic. It will always be our anxious wish to proportion our reviews to the value and importance of the works reviewed, though we cannot hope, in so doing, to give entire satisfaction to all parties--a consummation that, however devoutly it is to be wished, can never be rationally cxpected in this sublunary scene. We shall do what we think best, and appeal to old Chronos for judgment.
In our first analysis of Mr. Clarke's work, we concluded the subject of “ Watery Discharge.” We now come to the third and last chapter, which treats of "the Purulent Discharge.” The characters of this, are a heavy, yellowish, opake fluid, possessing little tenacity.” Though small in quantity, as compared with the watery discharge, it is far more exhausting to the constitution. Pus may be secreted from membranes without breach of surface, and is then unmixed with blood, which appears, after any violence, where the discharge is from an ulcerated surface—a tolerably fair criterion, Mr. C. thinks, as to whether the pus is secreted by a membrane in a state of inflammation or ulceration. But as a nice distinction of these cases is not always easy, our author first points out those cases of purulent discharge, appearing to arise from the female mucous membranes in a state of inflammation, and, secondly, those other cases, where the pus proceeds from an ulcerated surface.
The mucous membranes lining the vagina, the uterus, and the fallopian tubes, are very differently affected during inflammation. In the two laiter, coagulating lymph is gencrally extravasated, when the inflammatory action runs high. In painful menstruation, (inflammation of the mucous membrane of the uterus) flakes of coagulating lymph are almost always thrown off-in some cases forming accurate casts of the cavity; and this has happened in the fallopian tube also. Sometimes, however, the uterine mucous membranc will sccrcte pus, and this being discharged per vaginam, will render it doubtful whence it proceeds. At other times, the purulent secretion will be retained in utero, in consequence of adhesive inflammation of the cervix uteri. Coagulable lymph is rarely the product of vaginal inflammation- pus is produced by a very slight phlogosis there.
1. Purulent Secretion from the Ulerine Lining: When this finds its way readily into the vagina, there will be few other symptoms than a sense of heat and uneasiness in the passages. In some cases, where the vagina is wholly free from inflammation, the patient experiences acute pain in the back and bottom of the abdomen, which being severe and constant, the practitioner examines, and finds the uterus tender to the touch, its size being also increased, resembling the viscus when impregnated. The uterus enlarging, the case is still doubtful, till, suddenly, a large quantity of offensive pus escapes, and relief immediately follows. It is no wonder ibat an unfavourable prognosis is sometimes made in these cases, the practitioner fearing (and with reason) that some morbid alteration of structure is taking place in the uterus. Two or three cases are here related in illustration. In one case, the uterus burst and discharged the matter into the ahdomen, death being the necessary result. In the other case, the matter found its way into the rectum, and was voided by stool, with ultimate recovery.
Treatment. The symptoms will naturally point to the proper treatment--which is that employed in removing in