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This danger does not seem to attend their cure by the antiphlogistic treatment, which, when prudently conducted, diminishes the tendency to inflammatory action in the constitution, and does not, like merely local applications, destroy it in one part only to reappear in another."

Amer. J. of the Med. Sciences.

For the Medical Intelligencer.

Instrument for removing Urinary
Calculi without the Operation of
Lithotomy.

THE instrument proposed consists of a strait silver catheter, of considerable diameter, which encloses another of steel, terminated at its lower extremity by three branches. These branches, which are intended to grasp the stone, are made to approximate by withdrawing the steel catheter a short way within the outer one. The cavity of the inner catheter is intended to admit a steel rod, to which may be affixed, at pleasure, a simple quadrangular drill, or a strawberryshaped file, or a trephine. By the aid of a spring, the Lithontriptor, as the inventor has called it, is pressed equably inwards, and it is made to revolve with velocity by means of a bow, after the manner of a common hand drill. Such is the principle of the construction of the instrument. A Report has been drawn up by Chaussier and Percy, who were requested by the Royal Academy of Medicine to examine into the merits of the invention. This Report speaks in very strong terms of the success which the reporters witnessed, in repeated trials by the inventor; and there can be no doubt, from the distinct and precise evidence adduced by them, that none of the means pre

viously suggested for the same purpose, can compete with the instrument now proposed.

In March, 1822, the above Report was made by MM. Chaussier and Percy to the Royal Academy of Sciences, as a committee appointed by this body to investigate this invention and asserted improvement. The authority of

these names is not small. Three cases are given which were operated on in their presence with complete destruction of the stone in each, the nucleus of one of which was a bean..

These gentlemen in their report give a sketch of the progress of the attempt to fulfil the object in view, the discharge of the stone without an operation.

Dr. Civiale first conceived the plan of the mechanical destruction of the stone while in pursuit of a solvent for this purpose. Being desirous to obtain portions of the stone to ascertain its nature, he was devising means to effect it, when the suggestion arose that the whole stone might be so destroyed. This was in 1817. But to pass a strait sound through the urethra was the first and most difficult step. By patience and practice M. Civiale soon was enabled to introduce it with facility. The breaking of the stone is heard according to its consistency, and the operation proceeds at intervals; the blad der is washed out with warm water, which brings out with it the powdered fragments of the stone.

Three cases were reported by a committee to whom the subject was referred. The first case required three different settings to complete the destruction of the stone. The committee sounded the patient, a young man 32 years

old, and were satisfied that it was a complete cure. Drs. Larrey, Majendie, Serres and several others were present at these operations.

In the second case, the patient aged 40, the urethra was previously distended, the calculus was supposed to be of the size of a chesnut, and the French chesnut is considerably larger than ours; the noise of the operation was more obscure than that from the first; this required four meetings, at the last of which the lithontriptor was not used, but the forceps of Hunter effected the extraction of some fragments, and the forceps of Civiale the pellicle of a haricot bean which was extracted at a previous meeting, and which had its shoot protruded in full germination; the patient was entirely relieved.

In the third case dilatation was also used; the patient was a young man, who had been troubled with the complaint 18 months. The stone was supposed to be of the size of a pigeon's egg and of moderate hardness. Four meetings were had; at the second, nothing was done, as the calculus could not be found; no difficulty was found in its destruction afterwards. In this, as in others, masses of mucus were extracted with the forceps.

The committee think the invention glorious for French surgery, honorable for the author, and consoling for humanity.

Fortyone cases have now been operated on by M. Civiale, as may be seen by a table he has published, of which one only has failed of being cured, and though several patients have died some time after, it was not in consequence of

the operation, but their autopsic examination discovered no particles of calculus in the bladder.

From his experience M. Civiale has concluded, 1st, that calculi the most recently formed are most easily removed. 2d. Large calculi, organic changes in the bladder, swelling of the prostate gland when considerable, organic derangement of the kidneys, and other organs, are very unfavorable complications, though not always forbidding the operation. 3d. There are some cases in which it would be altogether imprudent to attempt operating; of these he has had a number. In some, an irritable bladder prevented, and in others the disorganization of parts. One of these was interesting; two calculi existed, one of which was wedged in the urethra, after perforating which with the lithontriptor, he advised the patient to undergo the operation of lithotomy; he consented, and M. C. cut down on the stone in the urethra, extracted it broken, cut open the neck of the bladder and extracted the other, which was three inches and three lines in circumference. The patient recovered.

Dr. Michael Joseph Brousseaud, exsurgeon major of the army, and member of the legion of honor, has reported his own case to the Academy of Medicine, having been operated on by M. Civiale in 1825, and cured after six operations. He speaks highly of the invention, and though the discharge of some blood followed each operation, he says there is nothing frightful in it, that the patient may go out two days after, and that in certain cases patients will find it "an

easy and sure mode of being delivered from a disease which alarms without ceasing."

Finally, MM. Roux, Cloquet and Chegoin, in a report to the Academy of Medicine, say," that it proves indubitably to the Academy the possibility of destroying in the bladder and extracting by the urethra without an incision and by means of strait instruments, a calculus of small size; that this operation, though requiring to be repeated several times, not without pain, is far from presenting the evils of lithotomy."

"We ought further to say that one of us has assisted at five operative sittings of M. Civiale, by which a patient having a soft stone, of recent formation and from an external cause, was happily delivered; that he was well satisfied with the operative proceedings and dexterity of M. Civiale, and without examining the question under a general point of view, we may conclude from what we have seen, that stones of small size and friable, are easily broken in this organ, and taken out through the urethra. These conclusions might be extended from other facts which have been published; but we repeat we only wish to draw ours from what we have witnessed."

For this operation much dexterity is required, and a perfect knowledge of the obstacles and accidents which may occur. From a friend in Paris I learn that Dr. Civiale possesses these qualities in an eminent degree. He is about to operate on Gen. Armstrong of London, Baron de Zac of Italy, and several other persons from Scotland, Dublin, Germany and Spain. Should this method prove satisfactory, of which there

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OPHTHALMOLOGY.

On the Inflammation of the Membrane of the Aqueous Humor. By Dr. WEDEMEYER.-A scrofulous, rheumatic, and arthritic predisposition, contusions of the eye, and inveterate syphilis, Dr. Wedeme yer considers as capable of preducing the inflammation in question. The signs which he has observed to characterize it, are, little pain in the eye or external redness, want of transparency of the internal surface of the cornea, at the commencement, though the external surface remains moist and shining; subsequently small opaque spots on the internal surface, and cloudiness of the cornea. The aqueous humor is also cloudy, it is secreted in unusual quantity, and constitutes a true acute dropsy of the anterior chamber; the patient becomes nearsighted, myoptic, his sight is much affected; often the march of the disease is very rapid, blood is effused in the anterior chamber, and afterwards pus; sometimes the inflammation extends to the iris, the color of which part then changes. These symptoms disappear more or less slowly under the influence of an antiphlogistic and revulsive treatment, but collyria and other local means

are of little utility.--Langenbeck: neue Bibliothek fur die chirurgie und Ophthalmulogie; tom. 4. p. 66.

Observations on the Inflammation of the Capsule of the Aqueous Humor, Chronic Iritis following the Operation of Keratonyxis, &c. By Dr. G. C. SCHINDLER.-Dr. Schindler relates two cases of inflammation of the serous tunic of the aqueous humor. The diagnosis which he indicates, differs but in a few particulars from that of Dr. Wedemeyer. He asserts

that the color of the iris undergoes no change, but that the pupil closes, and sometimes takes an unnatural figure. The lymph poured out in the anterior chamber forms bands uniting the different surfaces, and sometimes produce a false membrane which closes the pupil. The inflammation terminates always by secretion, and never by suppuration; Dr. Schindler thinks that internal sympathetic ophthalmia hitherto considered as appertaining to iritis, have their seat rather in the serous membrane.

In the two cases which he has treated, calomel and the extract of belladonna were of great service, and he considers them as the best means that can be employed to cure the disease.

He considers simple inflammation of the serous capsule of the anterior chamber of the eye, contrary to the opinion of Professor Langenbeck and Dr. Wedemeyer, as different from the inflammation which sometimes follows the operation of keratony xis, because the latter is more complicated and slower in its progress. Dr. Schindler does not entertain so unfavorable an opinion of keratonyxis as Dr. Wedemeyer and Professor

Langenbeck; he has seen only a single instance of inflammatory symptoms succeeding this operation, and in this case a single bleeding relieved it; he advises that the cornea should be punctured more towards its centre than inferior part, because we thus avoid the danger of wounding the iris, the movements of the needle are less extensive, consequently there is less pressure on the lips of the wound; finally because the cicatrice, always trifling, speedily disappears totally. Ibid.

Deepseated Inflammation of the Eye.-Mr. Bury relates in the Medico Chirurgical Review for July last, an interesting case, treated by Mr. Wickham, which shows in a very striking manner the control of mercury over iritic inflammation, and its power of effecting the absorption of the effused lymph.

Case.-A woman, aged 21, corpulent and florid, has had a slow but continued inflammation in the right eye for two years, during which her vision has gradually become more and more indistinct, till, at last, it is lost. No appearance of inflammation of the conjunctiva or sclerotica,-pupil immoveably contracted, its edge surrounded with a margin of lymph, of a brownish color,--suffers much from deepseated pain of the eyeball. Considering it a case of chronic inflammation of the iris and choroid, and understanding that the usual antiphlogistic treatment had been fully and repeatedly gone through, calomel with opium was at once given, and as soon as the mouth was affected, which was in five days, an evident amendment took place in the vision, and a slight

mercurial action being kept up, she by degrees recovered her sight completely. Soon after this the left eye was attacked with deepseated inflammation, which was treated by a renewed excitement of the mercurial action. These attacks after a time were again and again renewed, and only yielded to the repetition of the mercurial action. At the close of an attack of inflammation, quin. sulp. gr. iij. three times a day were administered, in the hopes of destroying the disposition to a repetition of the attack. Slight attacks of superficial inflammation occurred subsequently, but in the course of three weeks she appeared well.

On the Artificial and Accidental Evacuation of the anterior Chamber of the Eye. By Dr. BASEDOw, of Mersebourg. Dr. Basedow considers the evacuation of the anterior chamber of the eye as the dernier resource in cases of ophthalmia, threatening to terminate in suppuration and destroy vision, and he represents it as capable of saving the eye in almost desperate circumstances. He has performed the operation only in four instances, but these were all crowned with success. He divides the cornea at its most dependent part, and makes the incision but onethird the extent required in the operation for cataract. In the cases in which he operated, the aqueous humor flowed with the pus, and the evacuation was repeated, as the chamber became refilled, till the incision healed. The cornea recovered its transparency a few days after the operation, and the cure was perfect. Dr. B. en deavors to explain the favorable

effect which the evacuation of the anterior chamber exercises over the progress of inflammation of the anterior parts of the globe, and cites the cases of disease where the spontaneous or accidental evacuation of the aqueous. humor, frequently repeated, is either useful in preserving the organ, or, at least, is without any real danger to vision. Among these are certain scrofulous and rheumatic ophthalmias, with superabundance of aqueous humor, extreme tension of the eye, and ulceration of the cornea, which gives exit to the fluid, and thus relieves the internal compression, and in the second place certain traumatic lesions of the globe, of which the author gives some examples.-Bulletin Sc. Méd. from Journ. fur Chirurg. und Angenheilkunde. t. viii. p. 594.

Hypopion.-Dr. Gierl, in a late work on this disease, recommends, if the inflammation does not yield to antiphlogistics, that the matter should be evacuated, not only when it exists in the anterior, but also when occurring in the posterior chamber of the eye; and in this latter case he proposes to make an opening into the posterior chamber through the sclerotica. Dr. G. has peformed this operation in a single instance only, but with complete success.

We do not believe that this mode of evacuating the pus has any advantages, and cannot advise an imitation of the practice.

Amer. J. of the Med. Sciences.

ON THE TREATMENT OF TETANUS.

Every means which offers the slightest prospect of affording relief in this truly indomitable disease, is deeply interesting to the

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