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fairs, it is manifest, that any judicious movement of the sound must be fruitlessly employed, unless the stone be of considerable size, or seated near the neck of the bladder. *
The pain and spasm so frequently excited on the living body (when tortured with calculi) by the introduction of any instrument into the bladder, must have been noticed by most practitioners who are versed in this branch of surgery; and it is fact, worthy of observation, and which should not be overlooked by the junior surgeon, that a similar attempt to pass either the sound or catheter on the dead subject, is evidently an operation pregnant with comparatively minor difficulties, seeing that the muscles subservient to these parts have lost their vital energy. +
Having thus slightly marked out a few leading impediments in the mode of sounding the bladder (which is scarcely noticed by surgical writers), without entering into a laboured detail of every step and stage relative to the subject, I am induced to infer, that the practical lithotomist will acquiesce with me in having suggested an instrument, the construction of which, when used with skill and adroitness, will surmount most of the incidental obstacles relative to the operation in question.
Explanation of the Plate.
A. A sound of the common length for an adult, with all that portion of the instrument from the anterior part of the bulb or point to the handle, reduced equally to about one-half its usual thickness or diameter, which diminished form renders it less liable to be acted upon by the urethra.
B. The apex or bulb of the sound of the usual proportionate size.
C. This part of the handle to be perfectly smooth.
December 8, 1816,
* In the course of an extensive practice, I have many times been able to detect the stone in the bladder, when other surgeons have repeatedly and fruitlessly employed all their efforts.
I have also been in the habit of occasionally sounding the urethra, to ascertain the place and extent of stricture, with this instrument, and sometimes using one made nearly straight, either of which excites less irritation, and is also moved along the canal of the urethra with greater facility than the bougie.
Reply to Dr Monro's Observations on the Discovery of the Action of the Oblique Muscles, attributed to Dr Mayow. By G. D. YEATS, M. D. Fellow of the Royal College of Physicians, London.
DR R MONRO's book of anatomy has recently fallen into my hands, and, in turning over its leaves, I find I am honoured by a notice in nine pages, devoted to prove that the merit I have awarded to Mayow, for a discovery of the true action of the intercostal muscles, has not been correct. In a juvenile work, published above eighteen years ago, it was very possible that the ardour of youth, almost always generous in its feelings, might have overstepped the bounds of correctness in attributing the suum cuique. It was not, therefore, without anxiety, that I turned to my long-forgotten publication, under the apprehension that, in my zeal to draw the public attention to the great genius of Mayow, I might have been his eulogist unjustly, at the expence of the literary reputation of the Monro Family. A reference, however, to the chapter of my publication, has contributed to confirm my original feeling on the subject. The anatomist knows that there are two sets of intercostal muscles, viz. the internal and the external; the fibres of the former run downwards and backwards, and those of the latter downwards and forwards, consequently, they decussate each other. Until Mayow published on this subject, it was universally believed, that these two layers of muscular fibres served different offices, viz. that the internal depressed, and the external raised, the ribs during respiration. To combat this doctrine, and to prove that the action of both sets of muscles conspired to raise the ribs and to widen the chest, Mayow devoted a part of his chapter on respiration, with reasonings exemplified by diagrams, and plates of the ribs and intercostal muscles. It is from the expressions which Mayow has made use of to elucidate his meaning, that Dr Monro has endeavoured to prove that he did not understand his subject, and, consequently, "that Mayow had no title what
* Outlines of the Anatomy of the Human Body, by A. Monro Junior, p. 123-131.
† Observations on the Claims of the Moderns to some Discoveries in Chemistry and Physiology. By G. D. Yeats, M.D.
soever to the discovery, that oblique muscles possess the advantages of performing more extensive motions than straight muscles are capable of doing." I must, however, premise, that no such general proposition as that just stated is to be found in the chapter on this subject in my book, and I have not leisure at this time to examine Mayow's work, to discover how far he is entitled to merit upon the broad basis of that proposition. I have indeed admitted, in my publication of 1798, that Dr Monro has very ably extended the principle of obliquity to the action of muscles in general. The whole of the arguments, however, were applied to the co-operating oblique action of the intercostals; and I beg it may be understood, that in this anwer to Dr Monro junior, I strictly confine myself to this particular part of the subject. It appears to me (and I appeal to the learned Professor's candour, as his quondam fellow-student under his venerable and respected father), that his detraction from the just merit of Mayow has arisen from a misunderstanding of (by hasty perusal probably), or from a want of a sufficient attention to, his particular meaning. Dr Monro, indeed, does acknowledge that he did not know, when he wrote his observations, that Mayow had taught that the internal and external intercostals co-operate in inspiration; and I presume he acquired this information, in consequence of having been induced to peruse Mayow, from the praise I had justly bestowed upon him. The following are Mayow's own words:
"Recepta opinio est, musculos intercostales tantum exteriores dilatando, interiores autem contrahendo pectori inservire. At mihi videtur rationi magis consentaneum ab iis utrisque simul pectus dilatari. Nempe affirmare fas sit, costas sursum tractas pectoris spatium dilatare, deorsum autem retractas idem contrahere. Supponimus enim hic (quod cuivis in sceleto videre datum est), costas cum spina et sterno non secundum angulos rectos articulari, sed angulos infra costas esse paulo recto minores; ita ut si costa sursum trahatur, ejus articulationes cum spina et sterno, versus angulos rectos accedant. Asserimus insuper a costis ad angulos rectos elevatis, pectus dilatari." P. 278-9. "Quandocunque musculus, duobus ossibus affixus contrahitur, os minus fixum ad alterum magis fixum accedit; quapropter, cum inferior quæque costa minus fixa est quam superior, necesse est, ut musculis intercostalibus etiam interioribus se contrahentibus, costa singulæ inferiores sursum trahanImo similis plane ratio obtinet in interioribus musculis ac
* Monro's Anatomy, p. 131.-
in exterioribus." And this Mayow beautifully and irrefragably proves by a diagrammatic plate of the ribs and intercostals, and then goes on to observe," Advertendum est hic loci, quod costæ cum spinâ ita articulentur, ut costa a musculis prædictis tractæ, facile ascendant et in orbem eleventur."-P. 281.* I add Dr Monro's words also, that the reader may see, at one view, the great similarity of opinion. Mayow, it will be remembered, published in 1674, and Dr Monro in 1794, + a difference of 120 years. "But," says Dr Monro," in treating on particular parts, I dwell chiefly on the structure and effects of the intercostal muscles, as a variety of opinions concerning their operation has, in the course of the last 100 years, been proposed, and as no author had explained the reason of the obliquity of their fibres, nor of their being disposed in two layers of decussating fibres; after fully explaining the structure, I endeavoured to prove, as Haller had done, but with some additional arguments, that both rows of intercostal muscles conspired to elevate the ribs, or that they were muscles of inspiration." After having asserted this, Dr Monro proposes his reasons and illustrations, that the first rib is so much tixed as to be almost immoveable, and that the second rib is more fixed than the third, and the third than the fourth, and so on downwards. The exact coincidence of these opinions requires no demonstration; but it is somewhat surprising, that, although Haller quotes Mayow, ‡ and that Dr Monro is well acquainted with the works of Haller, yet that both these great anatomical physiologists should not have given Mayow hisdue credit for the admirable explanation of the conspiring action of the intercostals; nay, even that Dr Monro should state, that no author had explained the reason of the obliquity of their fibres, nor of their being disposed in two layers of decussating fibres; and our surprise must be not a little increased, that the observations of Collins, Verheyen, and Drake, should have escaped the attention of Monro and Haller, when it is considered that they both quote these authors, who had become converts to Mayow's doctrine, and had also taken considerable pains to confirm his illustration of the beautiful mechanism of the thorax. The whole of the above quotation from Mayow
Tractatus Quinque Medico-Physici, studio Joh. Mayow, LL. D. et Med. Oxon. 1674.
† Observations on the Muscles, and particularly on the effects of their oblique fibres. Edinb. 1794. This is Dr Monro the father. His son is the present Professor, who objects to Mayow as the discoverer on this subject.
Elementa Phys. III. 206.
Several passages of Drake are referred to by Dr Monro in his publication
is passed over, and the Professor hastens to that part of the chapter containing expressions which, I conceive, do not militate against the particular doctrine which Mayow wished to inculcate, although Dr Monro is desirous of making him inconsistent with himself from these expressions. Speaking of the conspiring action of the intercostals, Mayow observes, "Et hoc ulterius adhuc ostendit musculorum intercostalium obliquus et contrarius situs. Ideo enim videtur natura musculos illos oblique costis inseruisse (quanquam iisdem sursum aut deorsum movendis recta insertio melius conveniret), quia costarum interstitia adeo minuta sunt, ut sí musculi isti rectis angulis insererentur, breviores essent, quam ipsa musculorum natura patitur, quapropter ut dicti musculi justam longitudinem obtinerent cos oblique, ut fit, costis insertos esse oportet, cum tamen obliqua hæc positio ad costas sursum movendas minus idonea sit, ideo natura, machinatrix sapientissima, diversi sitûs musculos constituit, ut dum hinc inde æquali nixu oblique costas trahunt, costa interim recte sursum ascendant;" and he then refers to his diagram for explanation, and adds, "Plane ut videantur musculi interiores simul et exteriores eodem tempore se contrahere et sociatu nixu costas sursum ducere pectusque ampliare.'- P. 282, 283. The learned Professor has quoted this passage, save the last sentence; and, with a view of drawing the attention of the reader to a particular part, he has printed "quanquam," &c. &c. conveniret, in italics, quoted and referred to it twice, as a triumphant_conviction of Mayow from his own words. But the Professor has misconstrued, unintentionally I imagine, Mayow's meaning, from his mind being occupied with the idea of the general effects of the obliquity of muscles, whereas the subject is here entirely confined to the intercostals. Dr Monro's own words, in a former part of his work, will shew that he
has overlooked Mayow's meaning. "But, to shew you," says the Professor, "in the clearest manner, that Nature may have other very different purposes in view, it will be found, that, in various instances, the strength of the muscle is diminished by the obliquity of its fibres. This is the case of many of the short muscles attached to the spine, &c.; but the most striking instance of this is to be found in the intercostal
De Venis Lymph. Valv. See also Observations on the Claims of the Moderns, &c. p. 177-197.
The Professor, making observations on the obliquity of the intercostals, adds, "Hence straight or perpendicular muscles between the ribs would not have had sufficient length for producing the proper motion of the ribs."-Anatomy, p. 118.