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it may be well to mention that she had never employed the instrument herself and persistently refused to learn how to introduce it.
“ The determining cause of the retention not being apparent, but suspecting it to be hysterical, I directed my efforts immediately to the improvement of her general condition, and by means of tonics and generous diet soon succeeded in building up ber strength. In the meantime, I gently cauterized the urethra from time to time, and applied extract of belladonna to the vaginal surface of the canal, with the effect of diminishing the sensitiveness of the lining membrane, but without producing any impression upon the real trouble. I now made a thorough exploration of the interior of the bladder, but discovered nothing beyond an unnatural degree of sensitiveness of the anterior wall. Suspecting that there might possibly be a circumscribed chronic inflammation of the organ in this locality, I injected a solution of nitrate of silver, ten and twenty grains to the ounce of water, directing the syringe toward the anterior wall. This was repeated several times, gave rise to no great suffering, but accomplished no appreciable good.
“ Having now thoroughly satisfied myself that no organic disease existed, I recurred to my original impression, that the case was one of hysteria, and treated it accordingly, but except that now and then during the defecation there would be a sudden flow and an equally sudden stoppage of the urine, no improvement fol. lowed. At the end of five weeks she returned home, her general health almost entirely restored, but still obliged to have the catheter introduced three times a day.
"After the lapse of three months, say, in April, 1866, she came to me again, her general health broken as before, and the local affection wholly unchanged. I put her upon bark and iron, ordered a liberal diet, and she again rapidly improved. I now watched her more closely than ever, interrogated her in regard to every influence, moral and physical, that could by possibility give rise to the state of things that existed, but utterly failed to obtain the slightest clue. I tried systematically to make a diagnosis by exclusion; summoned the several affections in the long catalogue of known causes of retention and brought them one by one to trial, but with no betier success. I called in the aid of my distinguished colleague, Professor Stone, whose skill in diagnosis is not exceeded by that of any one I ever knew, but although he fully appreciated the existing condition, he could not discover any satisfactory cause.
“As the case now stood, the whole difficulty seemed to consist in a want of proper balance between the sphincter and the muscular coat of the bladder. Whether there was an excessive development of power in the sphincter, or a diminution in that of the muscular tunic, I could not positively determine, but it was quite evi. dent that the organ could empty itself quite thoroughly if the excessive contraction of the sphincter was overcome. To this end, therefore, I addressed my efforts, and began by dilating the urethra by means of graduated bougies. This was continued only a few days, when, in consequence of the apparent suffering of the pa'tient and the resistance which she made, I was compelled to desist. But one other resource presented itself, which was to incise the urethra including the neck of the bladder. This I resolved upon at once, and the next day, the patient being under the influence of chloroform, I introduced a grooved director, and with a probepointed bistoury divided the whole thickness of the upper or anterior wall of the
urethra from the neck of the bladder to the external meatus. A large-sized catheter was then introduced, and worn for three or four days, when the patient found, to her great joy, that she could empty her bladder without the instrument, and therefore laid it aside. At first considerable effort was required and the urine flowed off slowly, but there was an evident improvement day by day. Unfortunately, in less than a week from the time of the operation, she was seized with an atrocious intermittent fever, which resisted treatment for not less than twenty or twenty-five days, when, upon being removed to her home, she recovered quite rapidly. During this time she continued to urinate, although with some effort, but with the subsidence of the fever, the bladder recovered its tone and no farther difficulty was experienced. It has now been nearly three years since the performance of the operation, and up to last accounts, only a few months since, there bad been no relapse.
“Remarks.- What was the nature of this case originally I am unable to determine, but from the history it seems probable that it was a peri-nepbritis, wbich, although not a common affection, and, so far as I am aware, not mentioned in systematic works on medicine, is occasionally met with in practice—a case being at the present time under my advice. However this may be, there evidently existed at a subsequent period, an irritability of the neck of the bladder with spasmodic contraction of the same. This continuing for some time seems to have resulted in an unnatural development, a slight hytertrophy, of the sphincter muscle. The irritability having passed off, the neck of the bladder was left in this condition, while on the other hand, the organ having been for some time daily emptied by means of a catheter, had lost somewhat of its normal tonicity. The muscular tunic was therefore unable to overcome the increased power of the sphincter, except occasionally, when the latter was off its guard, as during defecation, it would admit the passage of a stream of urine for an instant or more. Such at least was my reasoning and conclusion in the matter, and the result of the operation in a measure confirms the diagnosis."
HYGIENE, IN ITS RELATIONS TO THERAPEUSIS—A PA
PER READ BEFORE THE NEW YORK MEDICAL JOURNAL ASSOCIATION.
BY ALFRED CARROLL, M. D., Member of the National Institute of Letters and Sciences, Corresponding Member of the Gynæ.
cological Society of Boston, etc.
Dr. Carroll has produced here a suggestive little work, which all the young members of the profession may read with advantage, for although, as he remarks, the practising physician is seldom called for until the period of prevention is past and active disease is before him, still in the management of disease, a knowledge of many of the principles of hygiene is essential to success. In the limits of a single
address, like the one before us, all that the author could attempt was simply to indicate the points to be kept in view by the practitioner, without going into details' in regard to any. If he has pressed the claims of hygiene with more ardor than physicians generally would approve, it must be remembered that this is the error into which we are prone to run when one idea has possession of the mind. judice of the tanner in favor of leather as the best material for fortifying his town, is a very natural one. Paracelsus appears to Dr. Car. roll as the "prince of quacks," because he underrated the remedial excellence of the vis medicatrix nature, and insisted on antagonizing disease with active drugs. Now, according to our views, both drugs and the curative powers of nature are valuable in medical practice. Neither is to be dispensed with, nor either one more than the other. Paracelsus insisted too much on active medication. Dr. Carroll, perhaps, would rely too much on hygiene. Medicines, unquestionably may be abused; but is there not some danger of estimating their power too low? By all means let us accomplish all that can be done by the curative energies that reside in all living bodies, but let us, at the same time, avoid the error of bringing our materia medica into discredit. While regarding "pature as the great active verb, and drugs, as at best, auxiliaries, only aiding, not giving the full meaning," we must not forget that the auxiliaries are as essential as the principals, and that there are cases in which the active power is sometimes exerted in favor of disease rather than of restoration. It is by no means true of all disorders, that their tendency is to a healthy termination.
Dr. Carroll divides diseases into three classes: 1. Those which may be treated by drugs exclusively, unaided by hygiene. These, he thinks, are few, and are cases of poisoning, of mechanical obstruction, &c. 2. Those requiring drugs and hygienic agents combined, neither of themselves being sufficient. To this class he refers most diseases. And, 3. Those which may be treated to hygienic measures alone. This is a large class, and embraces not the self-limiting diseases, but nearly all functional disorders, and the complaints arising from deranged nutrition.
Practical medicine has derived signal aid from the discoveries of modern physiologists concerning the process of assimilation. One part of the body may be starved, while the system generally is amply nourished some element of food being absent which is necessary to its nutrition. Muscle may suffer inanition, while the fatty parts of the body receive sufficient aliment. The brain is starved if phosphorus is
with held, and the blood is impoverished if the necessary salts are not supplied, though the muscles are furnished with the requisite nitrogen. Disease involves, in most cases, either “ defective supply or assimilation, or else excessive waste of one or more of the essential elements” of the system. The indication of cure is either to increase the supply or to diminish the waste. Upon our ability to fulfill it depends largely our success as practitioners of medicine. An indication of the highest value, in such cases, is not unfrequently the longing of the patient for some article of diet. This, as Dr. Carroll justly remarks, is often "the still small voice of some suffering tissue, urging its wants above those of its fellows.” This is a principle never to be overlooked in practice.
The opposite mode of dietic treatment has not been practiced with the same success, though there are diseases in which its necessity is still insisted upon. Regimen is held to be of the utmost importance in glycosuria. It may be important in other morbid conditions, but the process is too nearly akin to the irrational cura famis of the ancients ever to obtain much footing with the physician again. The "starvation diet” of Galen will never be revived, any more than the restriction of dropsical patients to solid food. But in rheumatism, where lactic acid abounds in the system, it may be proper to avoid vegetables which are converted into that acid by fermentation.
The suggestions of our author on the subject of ventilation and exercise are judicious, but he seems to us to be in more dread of overdoing the matter in respect to exercise than there is occasion for. Some young men, doubtless, carry their gymnastic feats too far. Dis. ease of the heart may result from violent exertion. But thousands die of disease resulting from inaction, where one dies from overexertion. The thing to be insisted upon, especially with the female native of society, is exercise. This is the great want of most females. Insufficient exercise is the root of most of their ailments. We hail roller-skating as an invention which promises them incalculable blessings. It is the greatest benefaction, in our judgment, conferred upon the sex in modern times. A more robust race of women, we have no doubt, will appear in the next generation in consequence of the introduction of this pleasing exercise.
Dr. Carroll is no friend to darkened chambers for the sick. Light is essential to development-to health; and recovery is accelerated by its influence. Sunlight, he insists, should be freely admitted into the rooms of the sick and convalescent, except where there is disease of
the eyes or brain. Clorosis, scrofula, in a word, all affections characterized by deficiency of vital power, demand light
The correctness of all this will not be questioned, but we are not prepared to accept the principle upon which the practice is based. We doubt whether it is owing to iron in the sun's rays that the light of the sun is so necessary to health, and so instrumental often in its recovery. Is there any “vapor of iron" in the solar spectrum? What are the constituents of the sun? is another question. That body may consist largely of iron, but the vaporization of that metal, and its transmission in the solar rays to the earth, through the cold space which they traverse, may be well questioned. It has been affirmed that light, if it possessed the billionth part of a grain of metal inertia, would be easily detected by delicate balances. The vapor of iron could hardly impinge upon them without giving evidence of its presence. We doubt, therefore, the truth of the remark of Dr. Forbes Winslow, “that the iron vapor detected in the sun's beams" is the agent which effects such changes in the color of plants and animals brought out of darkness into the light of the sun. We have no faith in the hypothesis that iron thus makes its way into the general circulation.
But we have not space or time for the pursuit of such speculations. The little work before us is practical in its character, and we recommend it to our readers as one which points out a profitable line of study.
ON THE PATHOGENESIS AND TREATMENT OF STERILI
TY IN THE HUMAN FEMALE.
BY WM. C. ROBERTS, M, D., OF NEW YORK.
In May last, I read before the New York Academy of Medicine a paper on the causes of sterility in either sex, based mainly upon physilogical relations.
Subsequently, Dr. Kammerer read a paper on the pathological conditions causing sterility, based upon a review of four hundred and eight cases, two hundred and one of which had occurred in his own, and two hundred and seven in clinical practice (Trans. N. Y. Ac. of