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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    recklessness or neglect, the operation is likely to be much less favorable. And if, in addition to these serious complications, the stricture should prove to be impassable, and the operation is neces- sarily undertaken without any guide to the bladder, it becomes one of the most difficult and uncertain proceedings of surgery. The alternative of puncture of the bladder from the rectum, or above the pubes, may, in rare cases, be adopted from necessity; but these measures afford only temporary respite, inasmuch as they leave the stricture, the cause of all the trouble, unrelieved.' Dr. Markoe says : ' It must be evident to you that the success or failure of it depends upon the condition of the patient for which the operation becomes necessary; that the dangers of the operation itself can hardly be separated from those of the disease for which it is performed. Being a last and only resort for a desperate con- dition of things, we cannot select our cases nor prepare them for the operation.' Professor S. D. Gross observes: ' The operation is by no means free from danger, and requires the most consummate skill for its successful execution. None but a madman or a fool would attempt it, unless he had a profound knowledge of the anatomy of the parts, and a thorough acquaintance with the use of instruments.' I have quoted the opinions of these distinguished surgeons— pertinent to the estimate of the operation—as fairly mirroring the advanced mind of the profession, and that I may express my gen- eral accordance. But I must insist, most emphatically, upon a correct interpretation of the words ' the operation being a last re- source.' While, beyond all question, the conscientious surgeon must propose to himself all other available and justifiable means of relief, yet, when these have been tried and have failed, the knife is not only the ' last resource,' but the only resource, and must be promptly and resolutely applied. The operation has often been deferred so long, that the bladder and kidneys have become irre- parably damaged by the action of the frequently-retained urine, and finally the knife is used when all operative procedures are con- tra-indicated. This long delay accounts, in a great measure, as I believe, for the large percentage of mortality which has followed the operation, and has brought it into disrepute.* So great was formerly this mortality, that, toward the emi of the last century, such authorities as Desault and Ohopart positively condemned the operation, and it fell into disuse. Its revival in our country is due to the late Dr. Alexander H. Stevens, who performed it 'with entire success, after the common modes of treatment had failed,' in the year 1817. The advances that have been made in our knowledge of the pathology and treatment of stricture of the urethra indicate a moderate and middle course to be pursued. It is now believed, by [* Case seven is a case in point.]