A treatise on hernia : with a new process for its radical cure, and original contributions to operative surgery, and new surgical instruments / By Greensville Dowell.

  • Dowell, Greensville, 1822-1881.
Date:
1876
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on hernia : with a new process for its radical cure, and original contributions to operative surgery, and new surgical instruments / By Greensville Dowell. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    perineal urethrotomy, even for forty-eight hours, is not only unne- cessary, but harmful. Unnecessary, because it does not fulfill the supposed indication of preventing the flow of urine through the wound, and because the contact of the urine with the fresh-cut surfaces does no harm, as is exemplified by lateral and median lithotomy, and also by the cases which have been detailed. Harm- ful, because the presence of the instrument—a foreign body—in the bladder, sometimes causes ulceration and perforation of that viscus, and does give rise to inflammation and to urethral fever. This is no doubt true with the gum catheter retained in the old way and of small size, but with the full size, retained by our mode, this does not occur. We have given a table of some of our cases after his formula, so the reader can compare statements. We had trouble whenever our catheter was taken out and allowed to remain out for the first ten days; being difficult to reintroduce and very painful. Our general plan was to remove it every day and clean it out, then reinsert it, tying it in by means of tape in the eyes and around the testicles. By this means the catheter was pushed down by the bladder into the urethra, and there it remained, and could not wound the blad- der itself. By pushing it up, the urine would flow, and there was no trouble. When we did not keep the catheter in, we put it in daily and kept it there for at least half an hour, and whenever we violated this rule we had trouble. In case four, P. M., a distin- guished lawyer, the catheter was removed only once in ten days, and there was a perfect cure with no bad symptoms. In case three, T. R. N., when the catheter was taken out, it was difficult to rein- troduce and very painful, but by reinserting and keeping it in, there was no more trouble, and the case was perfectly relieved, and when we wished to take it out, he was unwilling, for fear of like sufiering. In case five, when taken out, pain was severe and fever set up; but on reinserting the catheter, the fever subsided and the patient did well. He, too, was unwilling to have it taken out to be cleaned. From this, we conclude that the retention of the catheter is best and safest, and can do no harm if not tied in immovably. If tied to the testicles, no great pressure is possible; but if retained too long, it will cause suppuration, and its removal will give great relief. We make further quotations from Dr. Gouley that we highly approve of, and they speak for themselves :— The rough use of the sound [we use the catheter alone], will,