reach the staff. Some have imagined, that the introduction of the point of the knife, into the cavity of the bladder, must be dangerous, inasmuch as we are liable to wound the sides in searching for the groove of the staff. This objection is the result of an inaccurate knowledge of the state of the parts, for, in fact, we never grope in the bladder with the point of the knife, but with the finger push in the side of this viscus into close contact with the staff, into the groove of which the knife enters as soon as it has passed through the coats of the bladder. Others again have objected to this mode of operating, on the idea of its being more tedious in performance than with the gorget. This is also founded on a mistaken notion. True it is, indeed, that were a surgeon, who has been much in the habit of operating with the gorget to exchange it for the knife, he would undoubtedly be longer of performing the operation in the latter way; but the same does not hold good respecting those who have never before operated in either mode. From all that I have seen I would say, that the one operation may be as expeditiously performed as the other; but, even admitting that the operation with the knife uniformly required a little longer time, still I think that, if safer, it ought to have the preference. Description of the Plate. Fig. 1st. A straight staff, such as is employed in operating on the female, only smaller than these are generally made. When about to operate, a curved grooved staff is to be introduced into the bladder by the urethra; next a free incision is to be made in perinæo to the left or right, as occasion may require, of the raphe. We then dissect till we teach the membranous part of the urethra, which is felt just beneath the angle of the pubes, embraced by the triangular ligament; from this we proceed in our dissection inward, till we lay bare the whole extent of the prostate, and a part of the neck of the bladder. This being done, with a narrow bladed scalpel, we slit up the membranous part of the urethra, and conduct along the groove of the curved staff, the straight conductor which, for this purpose, must be slender. In the passage of the straight staff, we seldom find any difficulty, provided the canal of the urethra be exposed by an extensive cut; if, however, the incision into the membranous part be limited, it is hardly possible to insinuate the staff. Where the incision has been properly made, it rarely happens that we meet any obstacle in carrying in the instrument. I recollect, however, in one case, where the veru montanum was tumid, and the orifices of the seminal ducts large, that the difficulty was considerable considerable in passing both the curved and the straight staff; indeed, we could not introduce the latter till its point was raised into close contact with the groove of the curved one, by depressing the handle toward the anus. It is proper, in operating with the straight staff, to have, in the urethra, a full sized curved staff, with a wide and deep groove, by which we facilitate the introduction of the straight one. If it be thought proper, the groove of the straight staff may be closed at the end, by which we prevent the possibility of the point of the knife slipping beyond its termination. When the straight staff is fairly introduced, we are to feel with it for the stone, in order to ascertain that it really is in the bladder, which being done, an assistant is to withdraw the curved one. During the introduction of the straight staff, its handle is directed backward to the sacrum; but, on removing the curved conductor, the surgeon is to turn the handle of the former across the right tuber ischii, so as to point the groove of the instrument to the ramus of the left ischium. Next, in his right hand, he is to grasp the curved knife, Fig. 2d., and, laying its blade flat along the forefinger, the point of which is to project beyond the end of the cutting instrument, he is to insinuate both into the wound, opposite to the left tuber ischii; and, as he enters, he is to be careful to direct the point of the finger upward, so as to touch the neck of the bladder considerably above the trigonom, then, by pressure, the coats of the bladder are to be pushed in till we touch the staff, when, by turning the knife in the hand, and pushing its point in, we perforate the bladder, and fix the point of the knife in the groove of the staff: we are then to conclude by extracting both instruments steadily. During the extraction, the fore-finger is still to lie along the back of the knife, as without this, were the prostate tough, the two instruments might separate, leaving a part of the gland uncut, a circumstance which can never occur where the finger supports the knife. The midfinger may also be used to press down the rectum, but this is only necessary in those cases where the prostate is sunk into the gut. Deschamps observes, that this unnatural relation of the gland to the gut is sometimes confined to one side. In one man on whom he was operating with the lithotome of Frere Jaques, he found, on the left side, the gland so deeply imbedded in the gut, that he was obliged to operate on the right side, where the gland was more in the natural situation. It has generally been supposed, where the rectum was injured in operating with the gorget, that the beak had started from the staff; but, from this conformation of the parts, we see that the gut may, even where the gorget ran fairly along, have been divided, which is an additional argument against the use of this instrument, In operating with the gorget, where the abdominal muscles have been firmly contracted, the peritoneum has, by the pressure, been so far protruded between the bladder and the rectum, as to be injured in pushing the instrument home. This happened in the hands of Bertrandi, who, after having divided the prostate just as it ought to have been, found a portion of intestine present at the wound. He pushed back the gut, introduced the forceps, and extracted two calculi*. Camper also mentions, that, by rashly thrusting in the gorget, the peritoneum may be divided, an occurrence which can never happen if we employ the straight staff and knife. Besides, in operating with the gorget, where the levato ani was scarcely cut, and where a part of the prostate remained undivided, it was often difficult, after the removal of the gorget, to get the forceps in; most surgeons, therefore, allowed the gorget to remain as a conductor to the forceps. This is, however, only necessary where our openings are limited, and can never be requisite where the neck of the bladder and prostate are freely cut, as in using the straight staff and knife. Glasgow, Sep. 15th 1807. THE INQUIRER, No. XII. On the Present State of Medical Science in Germany. Quid sit pulchrum, quid turpe, quid utile, quid non. IN travelling through the different universities on the continent, our curiosity naturally leads us to inquire, what are the prevailing doctrines taught in these schools? by whom are they supported? what is the effect and influence of these speculations? and what is the probable chance of their being unintelligible, or meritorious and useful? To these questions, when asked about the state of medicine and philosophy in Germany, an Englishman might reply as a French emigrant did on his return to his native place, when his neighbours inquired about the language of the people where he had been: "Ce n'est pas proprement une langue, (dit-il), chacun parle son jargon, mais ils s'entendent en tr'eux." Deschamps, Vol. iii. page 143. tr'eux." The last clause of this sentence is no small praise indeed, when applied to the new schools of German philosophy; for the number of sects and systems is so great, that it is no easy task to understand even the terms employed by the different writers. Medicine comes in for some share of the miserable controversies which are going on between the partisans and opponents of the new system of "the philosophy of nature," as it is called. The prevailing doctrine now taught is pure idealism, and the disputes are like those between the idealists and realists of the middle ages, substituting useless questions, which do not admit of being proved, for practical inquiries. This scholastic philosophy has extended its influence to all branches of science; it has set all the heads a-reading and writing a great deal, without understanding much; and, like the philosophy of old times, only serves to trouble the state of science, already too much confused. Physical anthropology, organical physics, and psychological medicine, engross all the attention which the sober studies of anatomy and chemistry do not occupy. On subjects of practical medicine, very few books have been published for several years past; the catalogues at the Leipsic fairs have been filled with explana tions of the new, and attacks and defences of the old, theory of excitability, which has been grafted on the theory of our countryman John Brown. As the doctrine of this celebrated writer is essentially connected with the present state of medical opinions in Germany, it may not be amiss to give a sketch of its rise and progress in that country. It is only the chiefs of sects of every kind that acquire any degree of celebrity by their writings; hence it may be explained how the works of John Brown are more universally known on the continent than any of our best practical authors. The humoral pathology, or the doctrine taught by Boerhaave, prevailed, till lately, in all the medical schools in Germany; and, at this day, it forms the principal articles of faith amongst many practitioners. But the simplicity of the Brunonian theory excited great attention, and stimulated the professors to reject their former opinions, and adopt this new system with enthusiastic zeal. The principal supporters of the doctrine of excitabiliy were Frank, Weikard, Thomann, Marcus, and Joseph Frank. The first translation of the "Elementa Medicina" was published at Frankfort in 1795; several years after the doctrine itself had made its way into Italy, and revolutionized one half of the professors at Pisa, Padua, Pavia, and Milan. This rapid conversion was not so much from a conviction of the truth of the theory itself, but because something new in the shape of a system was wanted, since the old hypothesis of humours was become demontratively false. Moscati does not scruple to acknow ledge ledge this much in the preface to his translation of Brown's works, wherein he confesses his object was to oppose Brownism to humorism, which was prevalent throughout Italy, and particularly taught by the professor of the practice of medicine at Pavia. The partisans of Brown were naturally disposed to confirm the alleged superiority of his theory and practice, by observations made at the bedside of patients. Hence a series of clinical cases and experiments were published by Dr Joseph Frank at Pavia, and by Dr Thomann, first physician to the hospital at Wurtzbourg. These two records of Brunonian practice may be fairly appreciated by knowing the fact, that their authors have both given up the theory and practice of their idol and master. There is a spirit of inordinate generalization, a love of systematic novelty among the German physicians, which is unknown in this country, and, fortunately, we have no relish for its charms. Throughout every school, and every town, a most ardent zeal is shown in the pursuit of physical knowledge; vast numbers of men do nothing but read and write from one year to another; and it is astonishing with what avidity and emulation new inventions are received and propagated, The works of Van Swieten, De Haen, and Stoll, are now seldom heard of; the gastric and bilious hypotheses are sunk into merited oblivion; and the sthenic and asthenic theory of Brown is lost in the complicated maze of the new philosophical speculations. Schelling, a pupil of the celebrated Kant, formerly professor at Jena, now removed to Tubingen, is the founder of a new system, styled," the Philosophy of Nature." It is difficult to give an idea of what this philosophy consists; and, anywhere but in Germany, one would be astonished to hear men of sense and reflection declare, that what is called empiricism, sensible experience, and experimental philosophy, are necessarily and demonstratively false. And the demonstration, as far as it is intelligible, seems to proceed on some transcendental notions of the powers of the human mind and its external relations. Troxler, a young Swiss physician, who studied at Jena, and was there initiated into the mysteries of Schelling's philosophy, has become a zealous advocate and expounder of those doctrines. His Versuche in der organischen Physik," and his "Grundriss der Theorie der Medicin," are much esteemed by those who pride themselves on being able to understand them. Wagner is another popular writer on this department: he was originally one of Schelling's warm friends and admirers, and taught his philosophy at Salzburg; but he has now set up for an original thinker himself, and imitates his friend and associate in bringing forth something equally new and strange. Fichte is one of the most distinguished of the literati; but his writings belong more |