tion of the lachrymal passages, if, indeed, it be practicable to accomplish it. But it is plain that, except the falling of tears over the cheeks, the disease may be relieved; since, for this purpose, it is only necessary to convert this fistula into a simple wound.

In this brief analysis of the different methods adopted by surgeons, I have designedly omitted to give the preference to any one; though I admit that all do not combine the same advantages. The understanding of the surgeon ought to modify his procedure according to the circumstances of the case; for it is a fact, that he will rarely operate twice in precisely the same manner. This was the opinion of the celebrated Desault, whose loss France will long have occasion to lament. And I can declare that, during three years which I passed in studying surgery under that great master, I saw him constantly varying his mode of treatment; so many resources and such facility of accommodation, had he in his creative mind!

After the account now given of the various treatment of this disease, I leave it to every one to make his remarks on that which I adopted. It may be thought that my repeated incision was unnecessary; that the probe with which I opened the nasal duct, and which is nearly like that used by Monro, would be apt to lacerate the sac, and produce dangerous inflammation; that it is difficult to withdraw it from the nostril, and, indeed, impossible in cases where the opening of the duct into the cavity of the nose is diseased in a manner sometimes observed; that the seton I used was too large; and that, by passing it through the wound, I occasioned an irregular and deformed cicatrix. To all this I have but one answer to give: I did what appeared to me to be my duty: on another occasion I shall, perhaps, act conformably to the opinion of the objector, by pursuing my own, and by attending to the indication of the moment. If, in the case above related, I have not restored the organ to its natural state, it is because it was, perhaps, impossible, entirely to do so; or that, in order to accomplish it, it would have been necessary, after the cure of the fistula, to inject the superior lachrymal duct continually for several months, and to pursue the plan of Mejau in all its extent. But the want of time on my part, the loss of it to the patient, already fatigued by the tediousness of the treatment, and the possibility that nature, occasionally assisted by gentle compression, might complete the rest, determined me to content myself with having freed my patient from an

ulcer, which, to say nothing else, exceedingly disfigured her. And, finally, if by pointing out what I have done, and, perhaps, ought to have done, in order to obtain complete success, I can awaken the attention of my younger professional brethren, excite their emulation, and contribute any thing towards enhancing the good they may accomplish in similar cases, I shall flatter myself with the hope of having, in some measure, fulfilled the duty which every practitioner ought to feel incumbent on him, that of being useful to the profession, even although his exertions to be so should be made at the expense of his self-love.

ARTICLE VII.

CASE of SUPPRESSION of URINE, in which a Gum-Elastic Catheter, with a Bougie-Point, was used with Success: together with Experiments on the Treatment of GumElastic by Spirit of. Turpentine and Ether: Communicated in a Letter from PHILIP SYNG PHYSICK, M.D. of Philadelphia, to Dr. MILLER,

DEAR SIR,

Philadelphia, July 26, 1803.

N compliance with your request, when I last had the pleasure of seeing you in Philadelphia, I send you a short history of a case of suppression of urine, in which a gumelastic catheter, with a bougie-point, was used with success. To this I have added an account of the result of some experiments made with elastic gum, by which I hope a method is pointed out of using that substance in the formation of catheters, bougies, &c.

A middle-aged man was admitted into the Pennsylvania hospital in the winter of 1795-6, on account of a fracture of both his legs. The patient being laid on his back, the usual dressings were applied. No uncommon complaint was made until the afternoon of the second day, when I was informed that he had not been able to void any urine since the accident. On visiting him in the evening, I found the bladder so greatly distended as to form a considerable tumour in the hypogastric region, and the poor man in great distress. An attempt had been made to relieve him with a silver catheter,

but it could not be passed into the bladder. I endeavoured immediately to introduce a common sized bougie, but was unable to pass it beyond the bulb of the urethra. A gumelastic catheter was next tried, with no better success. The bougie was again had recourse to, and by bending the point of it to one side, I was enabled to pass it beyond the obstruction, and into the bladder. I allowed it to remain some minutes in this situation, in hopes that, when it was withdrawn, the urine would follow it; but in this I was disappointed, and therefore attempted immediately to enter a gumelastic catheter, but was not able to pass it beyond the obstruction at the bulb of the urethra. Under these circumstances I determined to cut off the end of a gum-elastic catheter, and tie on it two inches of the end of a bougie, because the flexibility of the bougie enabled me to bend it in the proper direction, which could not be done with the catheter. The instrument thus formed was passed into the bladder with care, and the urine entirely drawn off. The patient was afterwards relieved with this instrument twice every day for a fortnight, after which he became able to void his urine without assistance.

I have since had several cases in which it has been necessary to employ this instrument; and Dr. Wistar, to whom I showed it, has informed me that he has also met with several instances of suppression of urine in which he was successful with it, and in which, had it not succeeded, he would in all probability have been under the necessity of tapping the bladder. For a more particular description of the instrument see the annexed plate.

It has been long since known that elastic gum may be rendered very soft by spirit of turpentine, and that it can be dissolved in it by the assistance of heat; but it has been observed, on evaporating the turpentine, that the gum loses, in a great degree, its elasticity, and on handling it sticks to the fingers.

After a number of experiments, which I shall not relate because they were unsuccessful, I found that, by immersing it in vitriolic ether after the action of the spirit of turpentine, its original properties were regained. By exposure to the air, the ether evaporates, and leaves the gum in its original state. I have observed, however, that when the gum-elastic is dissolved with the assistance of heat in spirit of turpentine, it cannot be restored to its former state so perfectly as when it is made into a paste without heat. When gum-elastic is im