1
443 posits formed by the alkaline urine coming down from the kidneys. The patient has since done well; he was not aware of a portion of the stem having broken off, and will probably, for the future, avoid passing for himself instruments of so primitive a kind. It is rather curious that fragments of catheters, of bougies, stems of all kinds, &c., should, with such great facility, slip down the urethra, and towards the bladder, since the direction of the follicles, mucous glands, and muscular fibres is of such a kind as to favour expulsion, and resist introduction. Every surgeon is aware that a slight amount of force is always re- quired for passing an instrument down the urethra, and that some trifling opposition is generally encountered. It would therefore appear likely, when foreign bodies slip into the bladder, that the latter exercises a kind of suction, which favours their passage into the cavity. We need not remind our readers of the numerous cases of this kind which have been recorded in this journal. We shall just mention the pen-holder removed from the urethra of a patient by Mr. Birkett, at Guy’s Hospital, (THE LANCET, vol i. 1852, p. 196;) the hair-pin removed by Mr. Bransby Cooper, at the same institution, (THE LANCET, vol. ii. 1850, p. 483;) and the bristly stern of fir which a Frenchman, as stated in our " Foreign Department," was in the habit of passing down his urethra, (THE LANCET, vol. ii. 1852, p. 107.) Examples of globular bodies slipping into the bladder are perhaps more rare; but concretions will, as is well known, form exactly around the nuclei. A very striking instance of such formation was some time ago brought, by Mr. Haynes Walton, before the -Medical Society of London, (THE LANCET, vol. i. 1852, p. 227.) In that case, horse-beans had been maliciously passed down a poor man’s urethra, and phosphatic incrustations had formed around them in so exact a manner, that the whole presented the appearance of a globular calculus, within which; however, the bean lay quite loose, which latter circumstance might be made manifest, either by shaking one of the stones; or making a section. Being on the subject of foreign bodies introduced into the urethra, we would just allude to a case which was some time ago under the care of Mr. Stanley, at St. Bartholomew’s Hospital, and which exemplifies, not only the depraved taste to which we above alluded, but also affords another prool that urethritis, and some of its consequences, may be excited by mechanical irritation of the urethra. ST. BARTHOLOMEW’S HOSPITAL. Cat-gut Introduced into the Urethra ; Consequent Urethritis; Orchitis; Suppuration of the Epididymis on both sides; Recovery. (Under the care of Mr. STANLEY.) EDWIN T aged sixteen years, a pale, thin, and fair boy, I a clock-maker’s apprentice, who formerly used to be florid and in good health, was admitted Feb. 2, 1851, into Darker ward, under the care of Mr. Stanley. Nine days before admission he amused himself in passing a piece of new cat-gut, about twelve inches long, into his urethra, and so effectually did he do so, as to leave only about one inch of the cat-gut outside the meatus.. The foreign body remained, ac- cording to the boy’s account, but a few seconds in the urethra; it gave him no pain while he slided it briskly up and down, there was no immediate discharge when he removed it, and he states, moreover, that the cat-gut was never introduced afterwards. The patient was not in the habit of committing self-abuse. On the fifth day after acting so imprudently, the boy saw, after passing urine, a little blood come from the meatus, though none had appeared at the time of introducing the cat-gut, nor after- wards. The day when this sanguineous discharge took place, the patient had headache, shivering, and general uneasiness. This trickling of blood after micturition, general feverishness, and restlessness, continued four days ; the boy was then obliged to leave his master, and when laying by at home, the right testicle began to swell, and became painful. He had some medicine, but did not mention the above stated circumstances to the surgeon who attended him. At last, he told the fact to his master, who brought him to the hospital, where he was received under the care of Mr. Stanley. On admission, the right side of the scrotum was found red, and the epididymis swollen and painful; there was no discharge from the urethra, though the urine presented a yellowish-white cloud; the fever ran high; there were quick pulse, thirst, &c. Mr. Stanley ordered wenty-four leeches to be applied to the scrotum; a saline mix- ture, and an anodyne at night. On the next day, the febrile symptoms and pain not having abated, sixteen more leeches were placed upon the scrotum, a poultice afterwards, and antimony was added to the mixture. The inflammation of the epididymis could not, however, be con- trolled, and suppuration took place, the patient becoming at the same time very low and weak. The abscess on the right side broke spontaneously ten davs after admission, a great quantity of pus was discharged, and Mr. Stanley opened, on the same day, another abscess on the left side; this gave exit to much purulent matter, after which proceeding the patient felt considerably relieved. Beef-tea and brandy had been administered as soon as debility had come on, as well as small doses of mercury-with-chalk. The patient now improved rapidly, the abscesses went on discharging less and less, the boy gained strength, and was discharged about one month after admission, in a very favourable condition. This case might be looked upon as one of gono?-7-7tcea sicca, as it has erroneously been called ; but the simple fact is, that inflam- mation of the mucous membrane of the urethra had been mechanically excited; this urethritis did not reach the suppurative stage, but the irritation travelled along the ducts towards the epi- didymis, and attained there a very considerable degree of intensity. The purulent discharge from the urethra seems to depend not so much on the degree of irritation as on the kind. l4luco-pura- lent matter secreted by the genital organs seems to have the privilege of exciting a discharge of the same kind from the mucous membrane upon which it is deposited. Irritating injec- tions rank immediately after muco-purulent matter. On this head Swediaur’s experiment may be cited; it is well known that he produced a purulent discharge from his own urethra by in- jecting liquor ammonia: into that canal. And, lastly, bougies, or any other foreign bodies, by being roughly introduced, may give rise, as has frequently been seen, to a discharge simulating goriorrhoea in almost every respect. We should, therefore, be extremely cautious in framing our diagnosis, when called upon to decide on the nature of a urethral discharge. Not that the treatment will be materially different in respect of the causes of these discharges, but because questions of the most delicate kind are sometimes put to the surgeon, and he should be very cautious before he gives a verdict which may have baneful influence on the peace and happiness of families. Reviews and Notices of Books. The Dietetics of the Soul. By ERNEST VON FEUCHTERSLEBEN, M.D. Edited from the seventh edition. THE broad and shadowy line which separates the physical from the moral, the material from the immaterial, has always supplied the most exalted minds with themes of abstract speculation and profound thought. Divines and metaphysicians, philosophers and physiologists, have here taken their stand, and have expatiated with fond delight upon the half-revealed mysteries of the nature and destinies of man. It is here that our ablest writers have worked out practical problems for the benefit of mankind; but so little do we yet know of the true philosophy of this mysterious region-now dazzling our gaze with the light which immortality sheds upon it-now murky’with the dews of earth-now dark with visions of the grave,-that when an accomplished and intelligent writer chooses it for his theme, we read his essay as we listen to the tales of the traveller just returned from lands we have never seen And, independent of the popular interest attaching to the subject, there is something peculiarly attractive to the medical reader in psychological disquisitions. The reciprocal actings of mind and body upon each other’s feelings and functions, have, perhaps, never been duly or formally studied in relation to pathology and thera- peutics ; and by some of our more philosophical thinkers, the study of physic is felt to have been too technical and mechanical an affair. We have studied man as an animal, forgetting that he is also a thinking being; we have treated his diseases as the diseases of a horse. But so long as the heart beats, it is liable to throb with emotion, or to flag under the influence of despair. If superstition formerly usurped the dominion of sound philosophy, and attributed to demoniacal agency diseases in which the modern pathologist would find a satisfactory origin in certain lesions of the brain, the result was less mischievous to society than the modern monopoly of the quack, who has seized upon this unoccupied ground to plant his tent, and work his knavish spells.

ST. BARTHOLOMEW'S HOSPITAL

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443

posits formed by the alkaline urine coming down from thekidneys.The patient has since done well; he was not aware of a

portion of the stem having broken off, and will probably, forthe future, avoid passing for himself instruments of so primitive’ a kind.

It is rather curious that fragments of catheters, of bougies,stems of all kinds, &c., should, with such great facility, slipdown the urethra, and towards the bladder, since the directionof the follicles, mucous glands, and muscular fibres is of sucha kind as to favour expulsion, and resist introduction. Everysurgeon is aware that a slight amount of force is always re-quired for passing an instrument down the urethra, and thatsome trifling opposition is generally encountered. It wouldtherefore appear likely, when foreign bodies slip into thebladder, that the latter exercises a kind of suction, whichfavours their passage into the cavity.We need not remind our readers of the numerous cases of this

kind which have been recorded in this journal. We shall justmention the pen-holder removed from the urethra of a patientby Mr. Birkett, at Guy’s Hospital, (THE LANCET, vol i. 1852,p. 196;) the hair-pin removed by Mr. Bransby Cooper, at thesame institution, (THE LANCET, vol. ii. 1850, p. 483;) and thebristly stern of fir which a Frenchman, as stated in our" Foreign Department," was in the habit of passing down hisurethra, (THE LANCET, vol. ii. 1852, p. 107.) Examples ofglobular bodies slipping into the bladder are perhaps morerare; but concretions will, as is well known, form exactlyaround the nuclei. A very striking instance of such formationwas some time ago brought, by Mr. Haynes Walton, beforethe -Medical Society of London, (THE LANCET, vol. i. 1852,p. 227.) In that case, horse-beans had been maliciously passeddown a poor man’s urethra, and phosphatic incrustations hadformed around them in so exact a manner, that the wholepresented the appearance of a globular calculus, within which;however, the bean lay quite loose, which latter circumstancemight be made manifest, either by shaking one of the stones;or making a section.Being on the subject of foreign bodies introduced into the

urethra, we would just allude to a case which was some timeago under the care of Mr. Stanley, at St. Bartholomew’sHospital, and which exemplifies, not only the depraved tasteto which we above alluded, but also affords another proolthat urethritis, and some of its consequences, may be excitedby mechanical irritation of the urethra.

ST. BARTHOLOMEW’S HOSPITAL.

Cat-gut Introduced into the Urethra ; Consequent Urethritis;Orchitis; Suppuration of the Epididymis on both sides;Recovery.

(Under the care of Mr. STANLEY.)EDWIN T aged sixteen years, a pale, thin, and fair boy,

I

a clock-maker’s apprentice, who formerly used to be florid andin good health, was admitted Feb. 2, 1851, into Darker ward,under the care of Mr. Stanley.

Nine days before admission he amused himself in passing apiece of new cat-gut, about twelve inches long, into his urethra,and so effectually did he do so, as to leave only about one inch ofthe cat-gut outside the meatus.. The foreign body remained, ac-cording to the boy’s account, but a few seconds in the urethra; itgave him no pain while he slided it briskly up and down, therewas no immediate discharge when he removed it, and he states,moreover, that the cat-gut was never introduced afterwards. Thepatient was not in the habit of committing self-abuse.On the fifth day after acting so imprudently, the boy saw, after

passing urine, a little blood come from the meatus, though nonehad appeared at the time of introducing the cat-gut, nor after-wards. The day when this sanguineous discharge took place,the patient had headache, shivering, and general uneasiness. Thistrickling of blood after micturition, general feverishness, andrestlessness, continued four days ; the boy was then obliged toleave his master, and when laying by at home, the right testiclebegan to swell, and became painful.He had some medicine, but did not mention the above stated

circumstances to the surgeon who attended him. At last, he toldthe fact to his master, who brought him to the hospital, wherehe was received under the care of Mr. Stanley. On admission,the right side of the scrotum was found red, and the epididymisswollen and painful; there was no discharge from the urethra,though the urine presented a yellowish-white cloud; the fever ranhigh; there were quick pulse, thirst, &c. Mr. Stanley orderedwenty-four leeches to be applied to the scrotum; a saline mix-ture, and an anodyne at night.On the next day, the febrile symptoms and pain not having

abated, sixteen more leeches were placed upon the scrotum, apoultice afterwards, and antimony was added to the mixture.The inflammation of the epididymis could not, however, be con-trolled, and suppuration took place, the patient becoming at thesame time very low and weak. The abscess on the right side brokespontaneously ten davs after admission, a great quantity of puswas discharged, and Mr. Stanley opened, on the same day, anotherabscess on the left side; this gave exit to much purulent matter,after which proceeding the patient felt considerably relieved.Beef-tea and brandy had been administered as soon as debility hadcome on, as well as small doses of mercury-with-chalk. Thepatient now improved rapidly, the abscesses went on dischargingless and less, the boy gained strength, and was discharged aboutone month after admission, in a very favourable condition.

This case might be looked upon as one of gono?-7-7tcea sicca, asit has erroneously been called ; but the simple fact is, that inflam-mation of the mucous membrane of the urethra had been

mechanically excited; this urethritis did not reach the suppurativestage, but the irritation travelled along the ducts towards the epi-didymis, and attained there a very considerable degree of intensity.The purulent discharge from the urethra seems to depend not

so much on the degree of irritation as on the kind. l4luco-pura-lent matter secreted by the genital organs seems to have theprivilege of exciting a discharge of the same kind from themucous membrane upon which it is deposited. Irritating injec-tions rank immediately after muco-purulent matter. On thishead Swediaur’s experiment may be cited; it is well known thathe produced a purulent discharge from his own urethra by in-jecting liquor ammonia: into that canal. And, lastly, bougies, orany other foreign bodies, by being roughly introduced, may giverise, as has frequently been seen, to a discharge simulatinggoriorrhoea in almost every respect.

-

We should, therefore, be extremely cautious in framing ourdiagnosis, when called upon to decide on the nature of a urethraldischarge. Not that the treatment will be materially different inrespect of the causes of these discharges, but because questionsof the most delicate kind are sometimes put to the surgeon, andhe should be very cautious before he gives a verdict which mayhave baneful influence on the peace and happiness of families.

Reviews and Notices of Books.

The Dietetics of the Soul. By ERNEST VON FEUCHTERSLEBEN,M.D. Edited from the seventh edition.

THE broad and shadowy line which separates the physical fromthe moral, the material from the immaterial, has always suppliedthe most exalted minds with themes of abstract speculation andprofound thought. Divines and metaphysicians, philosophers andphysiologists, have here taken their stand, and have expatiatedwith fond delight upon the half-revealed mysteries of the nature anddestinies of man. It is here that our ablest writers have workedout practical problems for the benefit of mankind; but so little dowe yet know of the true philosophy of this mysterious region-nowdazzling our gaze with the light which immortality sheds uponit-now murky’with the dews of earth-now dark with visions ofthe grave,-that when an accomplished and intelligent writerchooses it for his theme, we read his essay as we listen to thetales of the traveller just returned from lands we have never seenAnd, independent of the popular interest attaching to the subject,there is something peculiarly attractive to the medical reader inpsychological disquisitions. The reciprocal actings of mind andbody upon each other’s feelings and functions, have, perhaps, neverbeen duly or formally studied in relation to pathology and thera-peutics ; and by some of our more philosophical thinkers, thestudy of physic is felt to have been too technical and mechanicalan affair. We have studied man as an animal, forgetting that heis also a thinking being; we have treated his diseases as thediseases of a horse. But so long as the heart beats, it is liable tothrob with emotion, or to flag under the influence of despair.If superstition formerly usurped the dominion of sound

philosophy, and attributed to demoniacal agency diseases in

which the modern pathologist would find a satisfactory origin incertain lesions of the brain, the result was less mischievous tosociety than the modern monopoly of the quack, who has seizedupon this unoccupied ground to plant his tent, and work his

knavish spells.