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p. 134. A globular pessary supports both the relaxed vagina and the pouchy rectum, and lotions of solutions of alum in decoction of oak-bark, with cold, &c. are recommended.
Inversion of the uterus, when the fundus comes through the os, is very seldom met with in the present improved state of midwifery; it is, however, occasionally met with in the chronic state, attended with a mucous discharge, and therefore the author treats of it in this work. It occurs in different degrees, and the general symptoms are the same as in the procidentia uteri.
"In a case where the uterus has been long inverted, and lies in the vagina, (the latter cavity having undergone no change, except from distention) it will not be advisable to recommend any other remedy, than the injection of some very mild astringent fluid, three or four times a-day, into the vagina. Some restraint will thus be placed upon the quantity of the discharge, and the parts will be kept clean by it. Pessaries are useless; for the vagina is already so filled, that nothing more can be retained in it." p. 148.
In an extreme degree of the inversion, when the uterus falls out, drawing down with it the vagina, the patient drags on a miserable existence, or dies from the constant discharge. But there are cases, of which the author relates one, where the removal of the uterus in this state has been performed with safety.
In Chapter XI., the author comes to treat of mucous discharges produced by whatever occasions an increased determination of blood to the sexual organs; and commences with hæmorrhoids, or piles. Women who have been frequently pregnant, and whose bowels are disposed to be constipated, are most liable to this disease. The author recommends the treatment to be adopted under the various circumstances in which the piles occur; and proceeds to a short chapter on the subject of ascarides in the rectum, which he considers as sometimes exciting a mucous discharge from the vagina, and which is to be cured of course by getting rid of the cause.
The reason for treating of carcinoma of the rectum, in Chapter XIII., is that though not a disease of frequent occurrence, yet, as it sometimes happens, and as in some of its symptoms and in its termination it resembles carcinoma uteri, it deserves a place here, being attended by a mucous discharge from the vagina." This is not a short chapter, and is judiciously employed in pointing out the many expedients which we ought not to resort to, if we would not do mischief to an incurable disease. The two next chapters, on the symptoms and treatment of the same terrible malady, when it attacks the uterus itself, contain something more direct, in the way of regulating the diet, and regimen, and general management of the consti
tution, by which, in the incipient stages at least, some benefit may often be gained: but he justly deprecates any attempts, by steel or other modes of invigoration, to restore the strength; which, in fact, they altogether fail to accomplish, and sometimes aggravate the symptoms of distress.
The XVI. Chapter treats of polypus of the uterus," an insensible tumour, attached to the internal part of this viscus by a small neck," to which both single and married women are subject, and women otherwise healthy, and whose uterus has suffered no violence. The author considers their cause as unknown. This is certainly one of those cases, in which not only examination is necessary, but which can only be cured by mechanical means. The author describes the symptoms, and marks the diagnostics from other tumours projecting into the vagina, for which the polypus may be mistaken, such as an inverted uterus, and the cauliflower excrescence of the os uteri. The ligature, as in other species of polypi, is the remedy in this case; and Mr Clarke mentions one instance in which the excrescence was so soft, that it broke away in attempts to fix the ligature. Some mechanical means of applying this, and the best mode of constructing it, are laid down by the author. It must be examined daily, and tightened if necessary; and when the neck of the tumour is sufficiently cut through, which happens at different intervals from four to ten or twelve days, the removal of the tumour is to be effected by the practitioner. The parts appear to recover their natural state very soon.
In Chapter XVII. the author treats of " the fleshy tubercle of the uterus," so first called by Dr W. Hunter.
"It is a hard, whitish tumour, sometimes nearly as firm as cartilage, situated sometimes upon the surface of the uterus, between the muscular and peritoneal coat, sometimes projecting into the cavity of the uterus, and occasionally imbedded in its substance. In some cases there is only one tumour; in others there are several. Their form differs very much; they are most commonly spherical or hemispherical, but sometimes they take an irregular shape. When they project into the cavity of the uterus, their surface is smooth; the contrary is generally the case, when they form upon the outer surface, the tumour having a granulated appearance. These tumours are sometimes not larger than a pea; sometimes they weigh several pounds, and occupy a great part of the cavity of the abdomen." p. 243.
This malady is mistaken for hydrops ovarii, and for pregnancy in its early stages. But its growth is much slower than that of the gravid uterus, and is not accompanied by any change in the mammæ, or affections of the stomach. It is not uncommon, and attacks alike married and unmarried women, and at all pe
riods of life after twenty: Its causes are unknown. Except a mucous discharge, the symptoms are principally those of pressure; irritations to pass urine and stools, and afterwards a difficulty and suppression of these discharges; cramps, and bearing down. The menstruation is various, and the constitution little affected. These tumours are not under the influence of physical agents, internally or externally applied; but there is some reason, the author affirms, to believe that they have been spontaneously absorbed. Some relief, however, may be occasionally given in emptying the bladder and bowels.
Chapter XVIII. contains a brief account of " warty tumours, arising from the vestibulum," which are attended with a mucous discharge, and accompanied by extreme irritation. Extirpation by various means, adapted to particular circumstances here stated, is recommended by the author, when they are not syphilitic. The following chapter treats of another excrescence from the parts, which is both alarming and painful, a "vascular tumour of the orifice of the meatus urinarius." This is a small florid excrescence, which appears to shoot from the inside of the urethra, is exquisitely tender, and readily bleeds. Its attachment is very slight, and it requires removal by ligature; after which it is less liable to re-sprout, than if removed by scissors or caustic.
The author then describes another disease of the female urethra, which is accompanied by a mucous discharge, which is a general thickening of the cellular membrane surrounding that canal, throughout its whole extent, accompanied by a varicose state of the vessels. This little but distressing malady is distinctly described, and seems to consist principally of an enlargement of the veins. Warm applications eventually increase it. The most speedy relief is obtained by puncturing the vessels, or bleeding them with leeches, and afterwards applying cold saturnine solutions, using pressure, and the horizontal posture, and keeping the bowels free.
The two last Chapters treat of the transparent mucous discharges that are not accompanied by any alteration of structure; first, of that arising from increased action of the vessels; and secondly, of that depending on debility. The former is one among other symptoms of that general plethoric state, which is the result of continued high living and indolence, and which is often accompanied with enlarged liver. Bleeding, purging, and proper diet are of course the remedies for all the symptoms. The latter is the result of any general cause of debility, such as long diseases, profuse hemorrhages, or anxiety of mind, living in hot rooms, and spending much time in bed, late hours, &c.
Sometimes it arises from suckling too long. The author describes the effects of the discharge in this case as very formidable, and sometimes even fatal; and directs the method of treat
With respect to the arrangement of this work, and the chapters introductory to it, we have been not quite satisfied; but the practical details are copious and valuable, and imply a considerable knowledge and familiarity with these subjects; and constitute a valuable contribution to this department of the profesWe think the book is too fine and expensive; and that the plates, with the exception of the representation of polypus, afford very little assistance, which description could not give; while they greatly enhance the price of the book.
On Gun-shot Wounds of the Extremities, requiring the different Operations of Amputation, with their After-treatment: establishing the Advantages of Amputation on the Field of Battle to the Delay usually recommended, &c. &c. &c. With Four explanatory Plates. By J. G. GUTHRIE, of the Royal College of Surgeons, London; Deputy Inspector of Military Hospitals. 8vo, pp. 384. Longman and Co. London, 1815.
F this book we may with
truth say, "Indocti discant, et ament meminisse periti." The experienced and intelligent surgeon will have pleasure in acknowledging the interest with which he has perused it; but to the junior and less experienced members of the profession, and especially to the younger military surgeon, this treatise of Mr Guthrie must prove an inva luable gift. A work of this kind was, in truth, wanted for their instruction; and the desideratum has been most happily supplied, not by an ordinary surgeon, but by one bred in the camp and in the field of battle. The reader, too, is introduced to this great school of military surgery, and becomes accustomed to its horrors, its dangers, and privations. But, amidst the difficulties and privations of active campaigns, it is delightful to observe with what order and precision the medical arrangements have been conducted during the dreadful war of the peninsula ; and to learn that our brave troops had the advantage of being
succoured by surgeons of first-rate talents and acquirements. Such, indeed, appears to have been the zeal and talents of the more experienced surgeons of the staff, that the camp and field were converted into schools for the instruction and training of the younger medical officers, by all the aids of lectures and demonstrations. And, though we know that almost all the medical recruits who were sent out to the army had received what is called a regular and liberal medical education, and had not received their certificates or diploma till after a regular inquisitorial examination, though many had received even the highest honours of medicine, yet the lectures and demonstrations of the camp were necessary to make them actual surgeons, and they soon became excellent.
Military surgery, like military success and glory, is indeed of late date amongst us; and, to judge from the specimen before us, we think we have now no less reason to be proud of the one than of the other.
The practical conclusions of this interesting volume Mr Guthrie disclaims as exclusively his own; and he wishes them to be considered, in every thing that is useful, as the result of the general experience of the British military surgeons who have served in the late campaigns.
One of the most important questions in the department of military surgery is that so often discussed, with regard to the proper period for amputating,-whether, when such operations are necessary, they ought to be performed on the field of battle, immediately or soon after the injury received, or not till after the removal of the wounded into hospital or quarters, and when the first train of supervening accidents have been subdued.
The whole merits of this hitherto disputed point are most ably investigated by our author in his first section; but the question seems now finally determined, by the experience of military surgeons, in favour of early and immediate amputation, when the limb cannot otherwise be saved. Wiseman, Le Dran, and Ranby, who learned their surgery in the field of battle, are all advocates for immediate amputation; and, perhaps, with the exception of Bilguer, the opposite seems to have grown up with, and to have been defended, chiefly by men of limited experience in military surgery. At the beginning of the wars which have for some time past desolated the fairest parts of Europe, both the Continental and the British surgeons rather inclined to the side of delay; but experience has now taught both the French and the British surgeons the advantages of operating on the field of battle.