Retrospect of the progress of surgery during the last decade / by Maurice Henry Collis.

  • Collis, Maurice H. (Maurice Henry), 1824-1869
Date:
1862
Catalogue details

Licence: Public Domain Mark

Credit: Retrospect of the progress of surgery during the last decade / by Maurice Henry Collis. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    divide these by an incision, carried from behind the stricture forwards to the sound part of the urethra. His narrow grooved staff, with handle of full size, down to the commencement of the curve, is well known. By a careful use of this staff the extent of the stricture anteriorly is readily ascertained, and its complete division secured. A new plastic material unites the divided surfaces, and is capable of being stretched by the use of bougies so as to make future contraction of great rarity. Other surgeons, prior to Mr. Syme, had divided strictures by cutting down upon the point of a staff passed as far as the stricture, and then cutting through it backwards towards the bladder, either with no further guide, or by the assistance of small grooved directors insinuated through the stricture from the wound. To this operation the name of “ perineal section” is limited. To Mr. Syme we are indebted for the operation of “ external division,” by which the urethra is opened behind the stricture, upon a grooved staff, and the stricture divided by a cut forwards along the raphe. Mr. Bryant, in his Clinical Surgery, gives a very good resume of the subject from a practical point of view; but, as is usual with him, with no reference to authorities. Few years pass by without some surgeon devising an instrument for dividing stricture by concealed knives or scarificators introduced into the urethra. This internal division of stricture has never had much favour in this country, and the instruments, with the exception of Stafford’s, are almost forgotten or unknown. A more dangerous mode of treatment can scarcely be conceived; and it is no matter of surprise to find M. Nelaton state that in more than half the number of incisions performed in Paris there is hemorrhage, and often to an alarming amount. Dr. James Arnotta states, that internal incision has often proved fatal from hemorrhage, infiltration of urine, and pyemia. He has also forcibly pointed out the impossibility of limiting the incision to the stricture, if it be made by an instrument which is either pushed backwards or drawn forwards; and he has striven to obviate all these dangers and difficulties by an instrument which shall cut by direct pressure upon the previously measured stricture. The Splitting of Unyielding Strictures, by a dilator, has been largely prac- tised by Mr. Holt, of Westminster Hospital, and apparently with great success. The infiltration of urine and abscess which would naturally be sup- posed to follow from such a proceeding do not do so; and this is the more extraordinary as it is generally the floor of the urethra that gives way. This plan of treatment is on its trial. The instrument consists of the bivalve staff invented by Perreve, of Paris, with rods of various sizes, which are run down between the blades, so that the stricture is suddenly distended by an irresistible force, and is ruptured accordingly. C 2 Medical Times and Gazette, February, 1861.
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