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terim had failed in carrying the catheter farther than the neck of the bladder, whilst the patient suffered from considerable hæmorrhagies from the rectum and urethra. He was now in a pitiable state, the symptoms being low and typhoid, the testicles swollen, the penis gangrenous, and the rectum prolapsed and livid. Our author punctured the bladder from the rectum, when six pints of altered bloody urine flowed out, and the prolapsus recti was reduced. The patient rallied in some degree, but the canula giving rise to great irritation, was removed, the difficulty of making water returned, and on the 28th, the operation of puncturing the rectum was repeated, after which the catheter was retained in its place for two days.

The unfavourable symptoms subsided, and on the 3d of November our author attempted to re-introduce the catheter. At first it penetrated, with some resistance, into an opening, but nothing is sued, and then by manipulation it was directed into the bladder and two pints of urine obtained. On passing two fingers into the rectum, a tumour like a full bladder was felt in the left side of the pelvis, on which our author was convinced that this really was a supernumerary bladder, succeeded in getting the catheter to enter it, and evacu ated three pints of urine. On injecting a bland fluid he felt this second reservoir become distended, which confirmed him in his opinion of its nature. For seven weeks it was necessary to perform the painful and difficult operation of catheterism for this unfortunate pa tient, but his career was drawing fast to a close. On the 22d of December he was seized with a rigor, peripneumony followed, and on the 10th of January he died.

Sectio Cadaveris. In the left side of the pelvis, between the rectum and ordinary bladder, was a membranous sac, equalling the latter in size, and closely united to it. The natural bladder, which we shall call the anterior one, was of its usual form, and in contact by its posterior surface with the unnatural, or posterior bladder, which was more rounded. The peritoneum

No. XXV. FASCIC. I.

was in exact contact with the posterior wall of both bladders; the anterior and external wall of the posterior bladder was united by cellular tissue to the left side of the pelvis. The right ureter terminated in the usual way; the left passed along the posterior and external surface of the second bladder, was much dilated at its point of contact with it, and passed on to the fundus of the true bladder behind the left spermatic cord and before the right. The left vesicula seminalis was closely united by cellular tissue to that of the second bladder. The prostate was only connected with the first; the veins of the plexus of the rectum and of the bladder were very much dilated.

The long muscular fibres which extend from the apex to the fundus of the bladder, were limited to the anterior one only. The posterior bladder was provided with circular and vertical muscular fasciculi, strongest at the junction of the two reservoirs. The muscular coat of the anterior bladder was three lines in thickness, so strong as to look like the columnæ carneæ of the heart, and, like them, leaving intervals between its fasciculi of fibres. The mucous membrane was not thickened. In the posterior wall of the first bladder was an aperture three lines in diameter, opening into the second. The parts around the aperture constituted the par tition between the two, the parietes of which were closely and almost insepa rably united.

M. Ehrlich looks on this as a satis factory instance of a congenitally dou ble bladder. We confess that the particulars do by no means carry conviction to our minds, but lead us to believe that the second reservoir was rather one of those exaggerated pouches from the bladder, which occasionally protrude like herniæ or staphylomata be tween the packets of muscular fasciculi. Many reasons, which will occur to the reflecting reader of the case, induce us to hold this opinion as being the more probable explanation of the facts. We do not readily perceive how this pouch or second bladder, be it which it may, gave rise to retention of urine. There might be a difficulty experienced in ex

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pelling its own contents, but why, or in what manner, should it operate in preventing the natural bladder, with a morbidly increased muscular power, from forcing the urine in the latter through the urethra? Surely there must have been some obstruction in the latter, and if such there was, we must look to it for the fons et origo mali !

X.

OBSERVATIONS ON THE PATHOLOGY OF VENEREAL AFFECTIONS. BY BENJAMIN TRAVERS, F.R.S. &c.*

This little work on the venereal is merely the offspring of an anniversary meeting of the members of the Hunterian Society, arrayed in a suitable tegument of pasteboard, and affiliated to those proprietors of so many hot-pressed bantlings, Messrs. Longman and Co. It is not to be expected, under these circumstances, that the foundling, should have swelled into the goodly corpulency of a full-sized octavo; we might as well expect that the shy miss should display, on her first coming out, the mature coquetry and confident ogle of the trained and accomplished madam. But to drop the metaphor, Mr. Travers' brochure is a short but shrewd essay, containing many points which are worthy of attention, and in some instances open to dispute. It is not consistent with the objects of this Journal to enter on the analysis of works on syphilis, but we cannot refrain from noticing some parts of the present essay, that we hope will not prove unacceptable to our readers.

GONORRHEA.

Mr. Travers observes that a purulent discharge from the male urethra or female vagina, occurs not unfrequently independent of sexual intercourse, and, as a sympathetic affection, may exist even in infancy. This should be borne in mind by practitioners, for several

* Octavo, pp. 75. London, 1830.

instances of serious consequences, from ignorance of this fact, have been recorded. The purulent discharge from the vagina of young children has been looked on as evidence of violation: indeed, if we mistake not, such a blunder was made very lately by a medical man, and gave rise to unpleasant discussions in the newspapers. The vaginal mucus of a maiden woman may be converted, by any inflammatory action of the parts, into puriform fluid; and attempts to deflower female children have been frequently found to produce a purulent secretion from the vagina, independent of any gonorrhoeal taint in the offending party.

"I believe that the vaginal secretion in either of these, or similar cases, is capable of communicating the infiammatory irritation to other mucous surfaces, either of the same or another individual. I have seen many cases of acute suppurative inflammation in the eyes of new-born children, where I was well convinced that the mother could not be the subject of gonorrhea, and others, in which the existence of that disease was indirectly ascertained, though it could scarcely have been suspected; but I never met with a case in which, upon strict inquiry, neither this nor the inflammatory leucorrhoea, so often attending upon advanced pregnancy, was not ascertained to be present. It is well known, that a woman so affected sometimes communicates a discharge to her husband; the case being not so rare, in reputable classes of society, as to render the fact doubtful to experienced surgeons."

From these premises, then, our author concludes, that the affection termed gonorrhoea is not necessarily to be referred to any specific quality of the matter. This is certainly true, but we believe that it ordinarily depends on a specific contagion. Mr. Travers, however, brings forward arguments to prove that gonorrhoea is of a simple inflammatory nature, and that "its ordinary origin is from the irritation of purulent matter. I say ordinary,' because we have seen that the disease may arise independent of intercourse, or after connexion with a sound female, the

urethral membrane being already irritated, or even inflamed, but not discharging purulent matter." If we perfectly understand the foregoing proposition, we have our doubts of its absolute soundness, nor do we think that the arguments on which it is bottomed are unanswerable. But n'importe; we pass to another point.

"Hitherto I have spoken of the gonorrhea, strictly so called, viz. the inflammatory secretion from the male urethra and female vagina. So long as sound surfaces remain on both sides, it is my belief that no secondary symptom of a specific character follows; that in fact no poison is formed. I do not say, that no such quality belongs to the matter which may be secreted by unbroken surfaces. Much of the difficulty of this subject has arisen from the supposition that either gonorrhoea or sores, or both, are the product of a particular virus or poisoned matter, and that a gonorrhoea necessarily gives a gonorrhoea, and a sore, a sore. This is altogether erroneous. Inflammation is excited by the irritation of matter from the inflamed follicles of the sound surface as well as from the ulcerated surface, and the difference of its effects upon the party who receives it, depends exclusively upon absorption or non-absorption, i.e. the formation or absence of a sore, a circumstance often accidental."

The proper gonorrhoea, or secretion from the unbroken mucous membrane of the urethra is incapable, says Mr. Travers, of producing secondary symptoms; but if an excoriation or an ulcer (gonorrhœal) be present, the matter which it secretes is capable of producing, by its absorption, secondary symptoms in the individual. "The absence of secondary symptoms in pure gonorrhoea depends, therefore, not upon any difference in the quality of the matter, but upon a law of the animal economy, that the inflammatory secretions of the sound surface are not absorbed into the system." Now we rather think that this doctrine is heterodox, that it is a heresy, and a keen disputant might shew, without much difficulty, that it leads to the notion of a similarity, if

not consanguinity, between the gonorrhoa and the lues. This at least is certain, that unless the characters of the gonorrhoeal sore be distinct and distinguishable, without much uncertainty, from the syphilitic chancre, they must come in practice to be treated as the same; and this will apply with even more force to the secondary symptoms, for unless the diagnosis of the syphilitic and the gonorrhoeal be tolerably easy in in itself, we shall merely have the history of the primary sore for our guide, a venereal history fallacious to a proverb! The following, then, are the distinguishing marks of the gonorrhoeal sore and secondary symptoms, which we give in our author's own words.

"The distinguishing features of sores produced by gonorrhoeal matter, are circularity, flatness without induration, whether raised or level with the surface; seldom solitary, often several; their greater frequency on the anterior and posterior verge of the prepuce, or beside the frænum; i. e. at the angles of reflection between the layers of the prepuce, or the close and loose investment of the glans, than elsewhere. In the female, they are likewise commonly situated at the junction of the mucous with the cuticular membrane upon the labia, or at their inferior commissure. Their margin is blunt but not indurated, the character of the granulatiou is spongy and indolent, and though they clean readily, they heal slowly. Lunar caustic, lightly applied, quickens them ; and the solutions of caustic, copper, zinc, and alum, escharotic astringents, are among the best local remedies.

"The secondary symptoms of the gonorrhoeal sore are as strongly marked, and present as distinct a character as those of lues. The glands in the groin are oftener enlarged and indurated, than otherwise, in protracted cases; but, as in proper gonorrhoea, the affection is sympathetic. The appearance of secondary symptoms is certainly not peculiar to these cases. The inflammation of the velum palati and uvula is diffuse and superficial; the surface is roughened with innumerable small tufts of white lymph, or pitted with small and shallow

thickening and elongation of its extensile cutis. These, I believe, are generally depending upon direct irritation. The verge of the anus likewise presents peculiarly characterized eruptions, which I have been sometimes disposed to regard as resulting from a similar cause."

So much for the sore and the secondary symptoms of gonorrhœa, and our author next adverts in succession to the inflammation of the conjunctival palpebra, tenderness and soreness of the flat bones, affections of the joints, &c. and finally that destructive malady gonorrheal ophthalmia. Mr. Travers remarks that the gonorrhoeal poison, like the small-pox, is communicated to the fœtus in utero by an infected mother, and likewise to the infant at the breast. Ulcerations of the mucous membrane of the nares, eyes, mouth, pudenda and verge of the anus, with papular eruptions and blotches upon the skin of the infant are the more ordinary symptoms. They yield to the hydrarg. c. cret. three or four grains night and morning. The succeeding directions with regard to treatment conclude the subject of gonorrhoea.

indentations, where ulceration has taken place. These are so slight as often to escape ordinary observation. They are seen chiefly upon the tonsils, uvula, apex and edges of the tongue. The sharp, deep and clean fissures of the tonsil, like the roughened and pitted tonsil, are consequent upon gonorrhoeal ulcers of the genitals; but this appearance is later, and I am disposed to think, induced by the partial and alterative action of mercury upon the system; in other words, a progressive stage towards the cure. The gonorrhoeal sore throat is accompanied by considerable irritability, to stimulant fluids especially. The excavated ulcer of lues, with its abrupt high-coloured margin, is not more strongly characterized, or more readily distinguished. The cutaneous affections are slight, and in character presenting less variety than those of lues, so far as my observation enables me to speak. The papular and squamous are the most common, the pustular and tubercular, occasional. The lichen and psoriasis upon the trunk and limbs, and the achor and acne indurata, thickly distributed upon the face and verge of the hairy scalp, are the forms which I have chiefly recognized. Purgatives, sudorifics, The attempt to discriminate and class and mucilaginous diluents, rest, and the minute varieties of primary sores, frequent tepid ablutions more than half and to establish corresponding deter- cure the disease by removing the cause. minate forms of cutaneous eruption, Over the running no medicine has any appears to me to suppose an uniformity power to be compared with the copaiba. at variance with observation, if not with Of injections, when the discharge is nature, and to render what is sufficiently gleety, none are equal in my experience clear for all practical purposes, studi- to those in common use, of lead, copously obscure. General character is a per, and zinc. The inflammation of sure and sufficient guide. This will the cervix vesica, spasmodic stricture, pretty infallibly distinguish the gonor- swelled testicle, phymosis, with irrirhoeal sore from the chancre, the gonor- table sores at the corona glandis, rhoeal sore throat from that of chancre, thickened and ulcerated prepuce, burand in most instances, the eruptions rowing abscesses between the bodies consequent upon either, from the erup- and integument of the penis, and tions produced by mercury. I have warts, in nine cases out of ten, are not, however, attained such nicety of consequences of inattention to cleandiscrimination, as to pretend to deter-liness, or exasperation from a totally mine the character of the primary sore from that of the eruption, with any feeling of confidence. The scrotum is frequently the seat of scabbing excoriations and eruptions of a peculiar character, connected with a morbid

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diuretics

wrong treatment in the early stage of the complaint.

"Neither the sores nor the secondary effects of the gonorrhoeal poison require more than the alterative tonic action of mercury; by its full action they are

cious. But since arguments on these subjects, when sown upon paper, breed disputes as countless as the warriors that sprung from the dragon's teeth, we shall decline them altogether. We do so on the present occasion with the less reluctance, as a revival of the Hunterian affinity between gonorrhoea and syphilis is not likely to be re-admitted into favour without keen examination.

For thirty or more cases of gonorrhoal sore, we now have but one of eating chancre, and the question arises to what ought this to be ascribed ? Let Mr. Travers answer it.

impeded, as it irritates and depresses not be impossible to prove them fallathe system disadvantageously. I will not say that the constitutional symptoms may not be cured without mercury; but the result of my experience is that the gentle action of that medicine, such as is given by Plummer's pill, the oxymurias hydrarg., and in some feeble systems by the hydrarg. cum cretâ, so materially expedites the curative process, that independently of any specific efficacy, real or supposed, I avail myself of its assistance. I am guided by its influence on the disease as to the extent and continuance of its use. The disadvantages of slowness in the cure and a continual tendency of the disease to relapse, or reappear in a new form, long since compelled me to abandon as a general principle, that of treating these cases without mercury. The sarsaparilla I almost invariably give at the same time in substance and decoction simple or compound; and in cases so slight, that I think the alterative not called for, or perhaps already sufficiently administered, I give with it free doses of the diluted nitric acid, with or without an equal portion of the tincture of henbane.

"If much irritability is present, especially in the throat affections, the sublimate, combined with small doses of the extract of conium or opium is an estimable form, and where constitutional debility prevails, the hydrarg. cum creta with a little rhubarb or Dover's powder, as the case may require. The indication of treatment is twofold, alterative and tonic; if much pain and irritability be present, a sedative should be added. The readiness with which the disease yields to this plan, steadily supported, it is most gratifying to witness."

LUES OR SYPHILIS.

Mr. Travers attempts with considerable ingenuity to prove, that the gonorrhoal and venereal poisons differ only in the degree of their intensity and the extent of their operation." We have said that his arguments are ingenious, but to us they are far from conclusive, indeed had we a mind for polemical discussion we think it would

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Judging from the records of history, there is much reason to believe that in the course of centuries the disease has been essentially altered in character, and certainly it has been subjected to no influence so direct and powerful as that of mercury. It is, perhaps, as much because that remedy has formerly been so indiscriminately and freely employed, as of late years so sparingly exhibited, that we find the disease comparatively so little formidable. There is, however, ground to believe, that what we may have gained upon the disease by mercury, has been obtained at the expense of life and limb. The poison has been bereft of its viru-» lence at the cost of the constitution, and for the cure of syphilis in an individual, scrofula has been entailed upon his posterity."

Another important fact is the daily amalgamation between the syphilitic and gonorrhoeal sores, an amalgamation which is throwing down the barriers of distinction between them, if indeed they are not already shattered, and which renders the administration of a certain proportion of mercury “unquestionably the safer practice in all sores." This admission on the part of Mr. Travers is a significant illustration of our remarks, and an ample apology for not having taken up the gaunt let.

"The great distinction of the syphilitic ulcer, primary and secondary, from the gonorrhoeal, is that the inflammation of the former is deep instead of being superficial and erythematous, and

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