'M ^y~ ^ »"V^>V£y AN INAUGURAL THESIS, JOHN A. ELKINTON. JSrtu 3[ersffj>, ^ BRID XTfeD V * TRIXTED.BT SJMEOTiT SIEGEK.1E&. " OcTOBEil«,182£l * • *\X % s ~ PREFACE, TO TJy. Philip Syng Physick, Professor of Anatomy* William Gibson, Surgery. Nathaniel Chapman, Practice of Physic et clin. pract. John Redman Coxe, Mat. Medica et Pharmacy. Robert Hare, Chemistry. Thomas C. James, Midwifery. Wm. E. Horner, Adjimct Prof'r Anatomy. GENTLEMEN, Ambitious to achieve the noblest object which can honour and emulate the character of a man, I this day begin the consummation which di- rects me to the most exalted, wished for attainment, or places me at once to the lowest grade of heart- rending animadversions and despondency. It is an epoch in life, which will be cherished with pleasure, or thought of with sorrow, to the latest periods of memory. The idea of success in such an undertaking, is like a dream to a thirsty man, who wakes but find& he is still w anting; or it is like the " music of carol," mournful, though pleasing to the soul. Its disap- pointments are more poignant to the mind, than the midnight gloom of harpies in a charnel-house. As it is insuperably exalted in its acquirement, it is tantamount degrading in its invectives. From the happy expressions of a modern writer, I behold already the seducing flowers, whose fasci- nating beauties " invite me to partake of them w ith- tv PREFACE. out restraint,'" but the autumn has not arrived, when the fruits will hang plentifully to reward the indus- trious and the meritorious. When I behold the vast number of heads and pens which have thronged the pages of medical history with the improvements of their art: when I consider, too, that most of these records have appeared to us from a European origin; I entertain a notion of patriotic pride, that the day is not very far distant, when the sons of republican Columbia shall be able to subvert their ascendancy, and triumph over the archives of despotic Britain. To this wished for probation, which "age and injury has hallowed1 deep," in the annals of medicine, I am at present but a fugitive disciple. The anticipation, however, of such a happy and boasted conjuncture in American science, fills me with aspirations characteristic o£ the insulted genius of my country. But, in thus liberally giving vent to intellect and sensation, it is not my wish to excite sympathy in the breasts of my preceptors, nor to animate them by my enthusiasm : I must be content for a time, to search out the path which has been trodden by a former traveller, whose labors have but cleaned away the rubbish for my easier access to its destination ; or, with more probity of confession, I am happy to imitate the stream that is " carried through a chan- nel formed by art for its course." But you, noble examples of industry and of genius, who appear to me like bright constellations, sur-' rounded by terrestrial meteors, imitate the bold river, which overflows a whole valley, and where it does not find can force a passage, by its own natural im- petuosity and strength. The boundless expanse which is opening before my eyes, and the stream of knowledge which appears to flow not beyond my reach, inspire me with a% zealous determination to fulfil the maxim, so appro- priate m medicine, nil desperandum. In attempting PBEFACg. V it, T feoi myself like the little child, who, with a shell, d- j: a hole in the sand, to contain the water of the ocean. Xatmr, however, has bestowed upon me a me- dium portion of intellect; fortune has afforded me an opportunity to improve, which many great men never possessed. It is by my own exertions, therefore, that I am to attain the transcendent acme of modern improvement. With this principle, which I enter- tain as a desideratum to future eminence, I proceed to a description of the subject intended for this es- say. In doing so, I approach it with a jealous un- certainty. If my success be equivalent to my en- deavors, I trust I have nothing to fear^ But future attestations must confirm the jeopardy. I engage in it like the infant commonwealth, at the time of the origin of the republic of Holland, which, it is said, represented a ship struggling amid the waves,. Tmassisted by sails or oars* with this motto,—Incer- turn quo fata ferant,—I know not whither fate may carry me. JOHN A. ELKINTON Port Elizabeth, April 15, 1822. I* ADDRESS To Joseph Cloud, Esq. one of the Officers of the United States' Mint. Respected Sir, The period has now arrived, when all- my labors are to be summoned and exposed, before that tribunal where merit does not fail to be rev, ard- ed, nor industry approved. Had I observed a strict adherence to your precepts, or. imitated your exam- ple, discretion would have afforded me unexception- able qualifications, industry would have dissipated a " shadow of doubt," which now hangs over me___ Entertaining, however, the gladdening hope of an honorable conclusion of such irksome, yet pleasing- researches, I now present myself before the ordeal of verbose attestations of my medical education. Before I experience this testimony, it is proper that I should acknowledge the many useful instruc- tions and admonitions derived from you, both in a physical and moral sense. During the two years that I have lived in your family, and been engaged in coadjuvancy with your son, in the arduous pursuit of medicine, I knew no other but a father's house; I recognised no com- panion but a brother. Your disinterested friendship, manifested tome throughout, must not be mentioned here. Your vir- tues as a man need not be mentioned to those who know them better than myself. EnterprizW i„ science, industrious in inquiry, of an indefatigable nature, you already rank among the brightest lumi- Wvnl rrC?UntT Ifui*ba™> of manners, a 2iTd'and ""remitting labors to benefit ™f and your country, be calculated to render IZt^tTt"^^ SUCh are the ^ell-known i our devoted friend, and well wisher, THE AUTHOR, To Dr. Joseph Parrish. Beloved Preceptor, It were wholly incompatible with the inten- tion of this essay, to attempt any such detail with- out descanting for a few moments upon your supe- rior claims to the full completion of it. Sensible of the high importance of the profession I am about to engage in, I cannot fail to cherish, as dear to my recollection, the many useful hints and practical: cautions, which you have so unsparingly impressed upon your pupils. But while I impose such obliga- tions to you, it would be injustice to my feelings, and an inexplicable digression from your practices, not to mention the name of your colleague, who is so much revered and respected by you, and whose name is always associated with honor and judgment. Dr. Phys-ick, as a surgeon, stands unrivalled.^— As a physician none excel him. He has become the idol of American physicians and surgeons; and w henever I speak of you, I must also think of him. Were I to say, in all your surgical lectures and in- structions, you directed our attention in an emphatic manner, to some occasional prerogative of Dr. Phy- sick, I might speak in terms of exaggeration. But his name has become the anthem of your class, and all echo his just praises,, without inquiry or scepti- cism. To you, and often from him, I owe many valuable precepts, which in practice will become " an anchor of hope" in many cases I may be called to. Not including the formal title of a preceptor, your familiar and pleasing intercourse with your class, allows me to say for myself and all,, we regard you as our medical father. Cherishing a lively sense of respect and gratitude, for your unfeigned zeal to promote my advancement in medicine, and your personal interest for my moral character, since I have been under your direction, I beg you to accept this discolored fragment, as the smallest tribute of respect and esteem, due from Your affectionate Pupil.-. INTRODUCTION. IN looking over the last number of Dr. Chap- man's Medical Journal, I was 'extremely gratis d to find contained in it, a description of a tiisease, which bears some relation to one 1 have selected___ Dr. La Roche has there detailed, at some length, a very extraordinary affection of the bowels, which fell under his care, and was successfully managed by appropriate remedies. Though the progress and nature of this case be somewhat different, yet the accuracy of its description, and the careful arrange- ment of its separate stages, affords me ample reason to suppose any analogous cases would meet with ap- probation in a dissertation. The diseasesof the alimentary canal are numerous and diversified. Before entering into an account of the disease of w hich I am to treat, it may be proper to give a pathological description of this structure, as concerned in diseases to which it is most liable. Bichat, by his attention to structures, has done a vast deal to the advancement of his profession, and deserves the respect of the medical world, by his more particular vigilance of inquiry into the use and nature of the mucous membrane. Inflammatory affections of the mucous membrane, daily become the subject of medical aid. We find this very extensively diffused. Beginning at the nares, we have under the name of the Schneiderian membrane, this mucous membrane. Extending our view s a little further, we trace it lining the nose, the fauces, and passing down through the trachea, is distributed to the remotest ramifications of the lungs. It also ranges through the sesophagus, lines the stomach, and whole alimentary canal, and ulti- mately passing through the rectum, terminates at the anus. When from any cause this delicate structure be- comes irritated or inflamed, we have t'isease present- ing in different forms, according to the nature (or Xii INTRODUCTION. violence) of the cause producing it. But I cannot hope to confine, within the narrow limits of a thesis, the various descriptions of raorbid actions which take place in it. My present object will not allow me to extend my research, beyond that which is commonly defined the alimentary canal, beginning at the pylorus. The most common and frequent disease appertaining to this i».i V. is perhaps Dysen- tery. Of this we are rendered sensible by the fre- quent discharges, attended with blood and mucus, which is so common an attendant on this disease, manifesting the rupture of some small hlood vessels, consequent to inflammation. I will first consider what takes place in inflamma- tion of the Schneiderian* membrane of the nose.— We have in the first stage coryza, with an increased. serous discharge, frequently attended with sneezing. After this there soon follows a discharge of more concrete mucus, by which the superficial vessels being irritated, rupture, and not unfrequently bleed. The same course of things may follow in the pulmonary system. It is by no means a rare circumstance, to see a thick mucus thrown off by coughing, and some- times tinged with blood. In the course of the in- testinal tube, there is but this difference. The dis- charges, at first, are not.apt to be so thin; but we soon have evidences of increased secretion and ex- cretion going on from the part. In inflammation of the mucous membrane, there is not so much danger to be apprehended, as inflamma- tion attacking the fserous membrane. In the for? mer instance, nature seems to carry the lancet in her own hands. As the nose is apt to bleed from increased action in its vessels, so also is it with the lining membrane of the alimentary canal. =* Or pituitary. ^Peritoneum* A DISSERTATION, &e. AFTER this prolix introduction, I wish now to lay before you the history of a disease, some cases of w hich have fallen under the notice of Dr. Fairish, which I shall describe from my notes on his lectures. It is a constipated condition of the bowels, which occurs occasionally under a very obscure form ; and might be confounded with a disease of an extremely opposite character—prima facie with diarrhoea. A mass of impacted feces may be accumulated in the intestines, either the colon or rectum, which proving a source of irritation, to such a degree, that the peristaltic action will be very much increased, without the patient being able to evacuate the offend- ing matter. In such cases, tlrere is mostly a liquid discharge, which is never succeeded by any relief to the patient. The indication in these cases, would seem most to call for astringents, and a practitioner might a priori consider himself safe, in resorting to them, when a directly opposite plan of treatment is required. This species of corstipa.ion (for it may be regard- ed as an anomalous shape of that disease) often ap- proaches in a very insidious way. A person may have dail v evacuations, but the bowels will discharge irreo-ularH, a part of irritating fluid, and retain a portion of" fceces, unt-1 at length this condition of tilings will be induced. In all such instances, we must naturally conclude, great pain and irritation will result. When such a condition of things docs occur, great efforts are made by the patient to ob- tain relief. The afflicted sufferer will strain, and have liquid stools, but no respite from pain will be experienced. In an individual thus affected, the con- tiguous inflammation may be, and often is very evi- dent. Thus we find a frequent disposition in the pa- tient to make watrr, and a practitioner unacquaint- ed with+he real nature of the disease, might suppose 2 14 him to be laboring under an affection of the bladder. But we can easily comprehend, how such local con- gestain the rectum, producing irritation and inflam- mation, might be prapagated to the bladder and pro- duce the phenomena mentioned. From the same cause, the uterine system has been suspected in females, when the primary complaint was traceable to impacted fceces contained in the bowels. There is a description given of this disease in one volume of the " London Medical Observations and Enquiries," in which is contained some cases. One of which that occurred to Dr. Fothcrgill, I shall mention here previous to enumerating those which fell to Dr. Parrish. • CASE—Dr. Fothergill was called some miles out of London, to see a gentleman who labored under a diarrhoea which resisted all the means, tried by the practitioner in attendance. On discoursing with the patient, observing that he had severe pain and dis- tress, and when he found no relief to follow the li- quid discharges, which were frequent, his views were at once extended to the cause. He stated that he believed it possible, an impacted mass of fceces in the bowels, might be the cause. Impressed with this opinion, he directed the apprentice of the apothecary in attendance, to introduce his finger into the rec- tum. This was done -, and it was found that an im- pacted mass of fceces was lodged there, which with his finger and the use of a spoon, he broke down and removed. By this simple expedient, a cure of the diarrhoea, and relief from all unpleasant symp- toms, was speedily effected. In another volume, I believe of the same work, there is recorded the case of a lady, an account of which I cannot give exactly as it may appear there, (not being able to lay my hands on the work lately,) but I have it in my power to give the particulars of ner case. CASE—This lady was affected with severe pain, and the symptoms were obscure. At one time the uterus was suspected, at another the bladder, and much was done for her, but she obtained no relief. L5 Two or three months had elapsed, before a practi- tioner was called into consultation, who really un- derstood the nature of her complaint. He suspected a mass of impacted fences in the intestines; which he brought aw ay although it was situated as high up as the sigmoid flexure. Relief in this instance was obtained too late. The poor patient was worn down, and finally yielded to the conquest. •A recollection of these cases, may account for the. mature understanding, and successful treatment of those, I am now to present you with, which were properly managed under the direction of Dr. Parrish. CASE 1st.—-Sarah Jefferson (a respectable wo- man) several weeks after parturition, was attacked with great pain and distress in the abdomen. When I visited her (says Dr. P.) she began a description of her case, by saying she labored under a " putrid lax." This term was applicable from the extreme foetor which attended her evacuations. On making farther inquiry, I ascertained that she had been af- fected for some time, and obtained no relief from evacuations. The disease of the abdomen increased. In observing her case I suspected a mass of impact- ed foeees in the bowels. My inquiries tended to con- firm the suspicion. She was taking Opium, Pout Wive and Bark to restrain the lax. I immediately explained to her the cause of her suffering, and my views of the subject. She comprehended me, and was fully disposed to enter into them. A plan of evacuations was entered on by cathartic medicines. First Oil. wras tried as she was a delicate woman. Her stomach retained the oil well and a number of doses were given. By this means I happily succeed- ed in bringing off a large quantity of hardened fceces, to her indescribable relief. She said she thought the mass had been lodged there for five weeks. The discharges at first were very offensive ; the foetor almost producing syncope. This speedily subsided and there was an end to the disease. 2d. About the same time *I attended a little girl }n the family of Captain O'Conner in Southwark. * Dr, Parrish. 1G This case very much resembled diarrhoea. But my suspicions were excited from the fact, that no relief followed the discharges, and that there was an im- pacted mass of foeees, which required removal. There was also in this case, considerable fever, which required the use of the lancet several times. .A large blister was applied to the abdomen, injections and cathartics were employed. She discharged a large quantity of hardened faces and relief was ob- tained. A mass of this kind may collect, without produc- ing any very severe constitutional affection, but which is very troublesome to the patient. 3d.—An old gentleman in this condition, took purgative medicines, but no relief was procured. He was sensible of some mechanical impediment. The nature of his case was explained to him;—and as lie did not wish any one about him, he succeeded with his fingers, in breaking down the impacted mass, free discharges came on, and the disease was cured. 4th. A son of Mr. Dnbarry, Merchant, a small boy, had great distress in his* bowel's. He strained much at stools, had liquid evacuations, mixed with a little blood; a mass of indurated fceces was sus- pected, and a short space of time confirmed the appre- hension. An injection which had been ordered, was resisted at once mechanically; and upon examina- tion the rectum was found filled with feces, like a ball, which proved an opposing barrier to previous resources.—The only way to proceed, was to break down the muss by operative means. This was ef- fected with a round handled desert spoon, taking the roundest part of the handle. This being done, the cathartic medicines administered, then acted: and lie was relieved. In all such cases, the diet should be such, as is not calculated to cause induration of the feculent matter. How tar the Charcoal would have effected manv oi the purposes, wished for, in some of these cases, 1 am unable to say, from any experience of my own. hut from the opinion of Dr. Chapman on this arti- 17 cle, I should suppose it might he heurslciai in those cases, attended with extreme fitter and putrescency. The indications for cure here are obvious. In the first place we are to endeavor to keep up the peris- taltic action by cathatic medicines; as Castor Oil, Sewa, Rhubarb with Soap, or what has been found exceedingly beneficial, a combination of 10 grains of Jalap, with 20 grains of Cream of Tartar. In addition to these injections are to be used, if they can be thrown into the bowels. The Warm Bath by inducing relaxation is of great use, and was found singularly beneficial, in the case of the child last mentioned. The Lac Sulphuris and Magne- sia, might here answer a very good purpose. If w^e can trace the cause, to a want of bilious secretion, it would be proper to endeavor to excite the action of the liver, by administering mercurial purges. To an- swer this end, 5 grains of the blue pill given every other night, would seem to be the most appropriate remedy^ These cases have appeared to me of rather unu- sual character; and as there would be a liability to confound such with diarrhoea, I have chosen more fully to impress them on my recollection, than to trouble' you with any instruction, to be gained from their history, to make such the subject of my essay. I shall be excused descanting on the gravitating tube of Dr. Wistar, by which he managed to pass injecting fluid up the intestines, in these cases; or t<> delineate the different resources of our art, which have been used, and which every skilled practitioner must be made sensible of, whenever he is to treat such a condition of the bowels. In some, we find mechanical means required to break down the of- fending mass ; in others, the vii modi of medicine, alone counteract the malady ; or at least the vis vita, or the action of the vital principle, overpowers it. Each of these I have endeavored to describe m their proper places; and I shall now proceed to detail a brief history, of a similar affection, substantiated by parallel cases, which more directly comprizes the boundaries of Surgery. 1^ TO THE rROFESSCIt OF SURGERY. Bit. GIBSON. 1 propose to close my dissertation, with the des- cription of some cases of an affection of the bladder, of rather an insidious character. I cannot, how- ever, take one step towards a surgical thesis, with- out first acknowledging the high respect I entertain for your professional abilities, and successful labors in imparting the improved state of the science of surgery to your pupils. The engaging manner by which you have amplified the theoretical researches of the student, by indefatigable endeavors to instruct and improve; the important operations which you have spared no pains to shew us, through the win- ter's toil, in all which we discovered agility and expertness, with a manifest knowledge of the sub- ject you were engaged in, calculated to encourage the intrepid operator, cannot fail to raise the admiration of every one at all conversant with your success. At the same time that you awaken in your hear- ers the spirit of emulation and industry, throughout all the departments of surgery, you would have none of us to imagine that any thing like perfection has ever yet been attained in any branch of it. Analogous in some respects with the preceding, I shall devote the remaining portion of this imperfect essay, to describe a disease which concerns the blad- der. This affection is characterised bv retention of urine, soreness of the abdomen on pressure, great pain and tenderness. The first of these, viz. reten- tion of urine, may come on slowlv, or be suddenly induced. Most of the cases I shall enumerate, are such as are incidental to low forms of fever; where the aid of the surgeon, if timely interposed, might oiien save a valuable life. In some fevers, the kid- neys appear to become paralysed, as in the yellow fever last summer, and no urine is secreted. This is different from those cases which I am about to consider. The following cases presented an opposite condi- tion of things 3 where the kidneys do secrete plenti- 19 fully, but from some obscure cause, the bladder is unable to evacuate its contents. But where wc have discharges taking place incogitabile et jussu Kbi'Jinis. By retention of urine, correctly defined, wre mean that condition of the urinary apparatus, where the kidneys secrete, but the bladder is unable to expel it. Or it may arise from some mechanical impedi- ment, or obstruction to the discharge, situated at the neck of the bladder, or in the course of the ure- thra. In every case of the kind, great pain and danger must ensue, if relief be not timely afforded. We generally ascertain this state of the bladder, by examining the parts above the pubis ; Where we most commonly discover an elevated tumor. This soon becomes tender to the touch, continues enlarging, and is attended with no inconsiderable distress to the patient. The system becomes irritable, and great febrile action speedily follows. It is not un- common, in many of these cases, after having tried the usual remedies, for a very deceptive symptom to come on ; which, without considerable circumspec- tion, is calculated to lull into a melancholy calm the young and inexperienced practitioner. I allude to the copious discharges which take place, after the occurrence of which, upon visiting the patient, we find the bed clothes, and parts contiguous, complete- ly wetted with the quantity. This state of affairs may exist for a time, and unless attended to, and relieved, w ill speedily prove fatal. The urine flows involuntarily, and the patient is wholly unconscious of what is going on. With all this no relief follows. The distention is still maintained. This inconti- nence in the discharge of urine should induce a prac- titioner to suspect the bladder at once in all casc^. Before attempting an exposition of the manner in which I account for this sudden and involuntary gush of urine, which is so frequent a concomitant, I shall add to it another peculiarity, which is still more delusive, and equally pregnant with danger. Cases have occurred, and occasionally do occur, where the urine is discharged periodically, by the 20 exigencies of the patient: an;! the bladder, notwith- standing, will be hi a state of considerable and in- creasing distention. A fuct of this kind occurred in the practice of the !a!^ Dr. Wistar, which is particularly in re resting, ami so fully confirms this fortuitous occurrence, that I shall give an account of it. He attended a patient with diseased prostrate gland. During his visits, the condition of the pa- tient led the doctor to inquire into the state of his urinary functions. He inquired if the urine were evacuated ; and was told that the bladder had emp- tied itself. Upon extending his sagacious investiga- tion still further, he examined and found the bladder had risen above the pubis, and that it gradually in- creased in size. Though we find here that the blad- der was under the control of the will, the quantity of urine voided was not adequate to the surplus secreted. it may be proper here to remark, that in some cases of low fever, attended with delirium, insensi- bility, &c. the bladder may be considerably distend- ed and enlarged, without being known bv the patient or his attendants. This I consider of* the utmost importance to be attended to. My Preceptor, Dr. Parrish, relates a case in his lectures, which strikingly illustrates this fact. He received a note from a physician in the coun- try, requesting,his attendance on a patient, who was affected with a low form of fever. After describing the nature of his fever, the writer casually mention^ ed, as an accidental circumstance, that he had in- continence of urine, Dr. Parrish, being aware of trie nature of the case, and anticipating the condi- tion of the bladder, provided himself with the ne- cessary instruments. When he arrived at the pa- tient s, upon examination he found the bladder very much distended. By the introduction of the catheter, he succeeded in drawing off large quantities of urine, and thus greatly mitigated the digresses of his suf- ferer. In June, 1812, while on a visit to Columbia, Dr. Parrish was invited by Dr. M'Corklc, to see a fe- >1 male, who was affected with alow form of fever, re- sembling Typhus Mitior. This patient was also seen by Dr. ^Griffiths. The case was one of an obscure form. A swelling was found to exist above the pubis. Ten days previous Dr. M'Corkle per- ceived a slight tumefaction, just above the pubis, which increased, and there wras some tenderness on pressure. She was a young woman, the mother of three children. At this time, she had a cool skin, tongue furred and brown in the middle, and she ap- peared to be in a state of Utero Gestation. But the fluctuation of a fluid could be felt, as in a case of ascites. Connected with this, the tumor was cir- cumscribed, filling up the epigastric region, which extended, and occupied the anterior and central part of her abdomen. It was also too long of forming, to be recognised as drops v. Dr. P. at once suspected the bladder. He enquired of the physician in attendance, relative to this point, and found by him that she had not a suppression of urine. Some time previous to this staV- of the disease, it was ascertained that for one dausliQ had passed no urine : but that at this time she did pass it voluntarily. To this fact all the nurses and attendants gave testimony. Disregard- ing this weight of evidence, the doctor requested the catheter might be introduced. She was already very much exhausted. The cath- eter was introduced, the urine poured out, and the tumefaction rapidlv subsided. After draining it off to the amount of a quart, there was discovered an evident faltering in the strength of the patient. The catheter was now withdrawn. The mischief, ho wevcr, was discovered too late. She became more exhausted than before the operation, sunk rapidly, and died. This faltering may be accounted for on the same principle, as tapping in dropsy. By taking away too suddenly the stimulus of distention, which Dr. Chanman regards as the « chief prop of existence^ V-d. the Professor of Surgery very judiciously can- * Or Griflitts. 1 ■» lions us against thus leaving the system m a flaccid ami unalterable state, for debility and death. 1 he tumefaction in these cases was evidently from the distended state of the bladder. The discharges which I mentioned took place, in the first condition referred to, where it was involun- tary and unsusnected by the patient, I will now un- dertake to expfain.—After the bladder attains a cer- tain degree of distention, rising above the pubis, and pressing against the abdominal muscles, it acts as an extraneous body, and stimulates them to ac- tion. Pain is at once induced, and by the spasm which results from this irritation and unnatural con- dition of the parts, the abdominal muscles take on contraction, and thus cause a portion of urine to be thrown off. The abdominal muscles being incapa- ble of action, below the surface at which they are at rest, of course cannot compress the bladder suffi- ciently to evacuate its contents.* By which ration- ale, the bladder must always contain a portion of urine, so long as the kidneys carry on their peculiar province of secreting, unless the officious surgeon interpose his ait. I have now enumerated cases which come on slow- ly, and where of an obscure nature. All of which required the catheter to obtain speedy relief. The catheter, in these cases of retention of urine, may be regarded as the primlm mobile, and is the " anchor of hope" in many of the diseases of the urinary organs. I shall now mention a case, suddenly induced, which wTas brought on by cold, and cured by Gin. Long continued exposure to cold, may bring on a spasmatic contraction, at the membraneous portion of the urethra, or in the parts contiguous, and thus cause retention of urine. In all or most of these cases, stimulants are? called for and may be often used with advantage. * It is understood that the independent action of the bladder is obtfided, by the paralysing influence of the disease, which more or less concerns_ that viscus; and its muscular contraction remains en- tirely enfeebled, 23 CASE,—A watchman brought a negro man to Dr. Parrish's, in cold weather, about midnight, who he found laying in the street, unable to pass his urine. He was requested to be taken to the watch- house, and kept warm till morning, when he would have him sent to the Alms House. The Doctor was not sensible at this time, of the suffering of the pa- tient. The poor fellow would not go, but continued howling under the window, until at length Dr. P. was obliged to get up, and let him in for his relief. He was shaking wTith cold, unprotected, and suffer- ing great pain. Dr. P. attempted to pass the cathe- ter, but th:- patient was so extremely cold, and shiv- ering, and the spasm so great, that his efforts were unavailing. Regarding it as the effects of cold, he gave him some 6ri?i. He then wrote a note which he gave to the patient, and despatched him to the Alms House. Next morning calling to see him, he was surprised to find, all unpleasant symptoms had sub- sided, the spasm was relieved, lie passed his urine freely* and went aw ay well. The diseases of the urinary passages, is a very interesting and extensive subject for investigation. The limits of a thesis, forbkl «ny elaborate discus- sion, which the subject prompts me to engage in. In that of which I have been treating, I have per- haps not given it that latitude of inquiry, which it most required. But I have already said too much: if I have erred in tautological recapitulation, it is because I was excited by the zeal which led me to it. If I.have not said enough, it is for want of prac- tical experience, to justify further details. With this, gentlemen, I conclude. I cannot but apologise for the errors, and imperfections, this dis- course contains. Sensible of the importance which is attached to it, I feel an unqualified hesitation in offering this faint picture before you. Surgical diseases at this crisis of my studies, ap- pear to me most interesting, and gratifying- in their successful management; many of which call forth all the fortitude of the mind, all the resources of our art. To become eminent, however, an anato- mical knowledge is the first step to qualify any mar 24 Without which, we might as well attempt to lea- verse the. atlantie. for any destined port, without a rudder to our barge to guide us. In fact may I not 'ay, that every error in surgery, both in operat- ing and disease, originates from a gross neglect of morbid anatomy, and consequent ignorance of the real condition of parts, subservient to such affec- tions If I-cannot say so at this enlightened day, I can easily behold yonder age, whose names a short century has scarcely buried in oblivion; when the searing iron was preparatory to fatal secondary hemorrhage, and huge knives like pruning hooks, with barbarous butchery, severed from the soldier, an arm or a leg, whose bravery would not allow him to declaim, against such brutal exercises of ignorant quackery. The importance of studying minutely, the struc- ture and functions of the human frame, and its basis, anatomy ; must be deeply impressed upon the mind of every man, avIio is desirous of practising his pro- fession, with reputation to himself, and benefit to the afflicted. The frequency of diseases ; the various situations and forms in which they present; the different states in which the same disease is often found ; the varie- ty of treatment depending upon diversity of circum- stances ; the knowledge of anatomy required in ope- rating ; and the danger of mistaking one disease for another, of a very different kind; are circum- stances which ought to infuse fear into the heart, and agitation into the consciences, of all those, who pre- sume to call themselves qualified surgeons, without at first having considered every thing, relating to so important a branch of their profession. With this advantage in surgical practice, which the professor of that science has often and emphati- cally expressed to us the importance of possessing- after having extorted from all our own physical abilities, and employed all the means which the art affords; mthe language of a teacher, we are next to invoke the kingdom of Heaven itself," from whence we never fail to obtain succor. Very respectfully, gentlemen, I remain yours, &c. JOHN A. ELK1NTON. ft vii "5 NATIONAL LIBRARY OF MEDICINE NLfl 0Ebci7fl7el E ''£*&■ NLM026978792