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"I take a fine gum-elastic bougie, and introduce it gently into the urethra; if I succeed in making it pass through the obstacle, I suffer it to remain until a strong inclination to make water is felt, and then withdraw the instrument softly, and the urine rushes through the passage which had been occupied by the instrument, flowing in a stream. When the patient has voided as much urine as possible, I introduce the bougie again, and leave it until a fresh inclination to make water comes on. In the mean while I bleed the patient, and apply twenty or thirty leeches to the anus and perineum, and prescribe a hip-bath, emollient anodyne clysters, rest, and abstinence.
If I cannot pass a bougie I use no force to thrust it in, but remove it. I take an impression of the stricture, and introduce a small bougie by means of a conductor; this bougie is succeeded by one of greater size; when the inclination to make water is very urgent, I withdraw at once both bougie and conductor, and the stream flows. I have recourse afterwards to the above-mentioned antiphlogistic means, and when the inflammation of the canal has been subdued, I commence the radical treatment. This mode of proceeding has always succeeded with me, and I have never adopted any other since I have entertained the ideas suggested in this chapter. If, which is not probable, the bougie should fail to re-establish the course of urine, it will be necessary, after having passed the second bougie, to introduce, through a conductor, a small gum-elastic catheter into the bladder, and draw off the urine in this manner." 133.
Such is the new method of treating stricture proposed, nay employed, by M. Ducamp. We doubt if it will ever find its way into general favour and use. It is too complex, too troublesome, to suit the generality of surgeons. The advantages attributed to it by its inventor may be said, in a general sense, to be two-the speedy and easy destruction and dilatation of the stricture, and the permanency of the cure. With regard to the first, many surgeons will probably think that the ordinary treatment by bougies is, in the main, both simple and efficacious in effecting dilatation. We must say that, from what we have seen and from our own experience, we feel no inclination to abandon the use of the bougie, that is, of our ordinary methods of dilatation; and experience is rather against than for the employment of caustic. If bougies and when we use this term, we mean the treatment by dilatation generally, employing, according to circumstances, bougies, gum and metallic catheters-if bougies, then, be carefully and dexterously used by a light hand and a practised one, the surgeon is seldom, very seldom foiled, even in cases of the worst description. The treatment by dilatation is more safe, and equally or more speedy than that by caustic, though the latter is now and then extremely serviceable.
But the ground on which M. Ducamp seems mainly to lean, is that of the permanency of the cure by his method. What guarantee have we of that permanency? on what known principle should dilatation, effected by caustic, be thus permanent? We know of none that can warrant the assumption— nay, facts and experience contradict it. We shall not commence a disputation on the subject, as the reasons for our opinion will readily present themselves to the minds and memories of medical men. Our space has been so occupied by placing the propositions of our author before our readers, that really we have none for discussions or arguments. We leave these propositions in the hands of our professional brethren, to believe, disbelieve, put them to the test of experience, or pass them by in silence, as they think most proper.
REPORTS ON THE EPIDEMIC CHOLERA WHICH HAS THROUGHOUT HINDOSTAN AND THE PENINSULA OF INDIA, SINCE AUGUST, 1817. Published under the authority of Government. 8vo. pp. 214, with Appendix, pp. 14. Bombay, 1819.
THE present is the Report on the Epidemic Cholera drawn up with the concurrence of the Bombay Government, and published at its expense. It is what is usually known as the Bombay Report, and presents, when conjoined with those from Madras and Bengal, a complete and most valuable history of the epidemic cholera, as it shewed itself in India. Before public attention was earnestly and anxiously directed to every source of information respecting this singular disease, the labours of the Indian Boards were comparatively little regarded. The danger seemed too remote to excite attention or to warrant alarm, and although a few physicians, attracted by curiosity or by partial motives, devoted a slight degree of consideration to the subject, it was never fully investigated even by them. Many bad consequences have ensued from this general professional ignorance, but the effects resulting from the state of imperfect information and semi-knowledge, disseminated by the dabblers in the Indian reports, have been infinitely worse. Statements of false facts have been boldly made, and pertinaciously persisted in; a colouring has been given to other facts and opinions which possessed a real existence; general impressions have gone abroad founded rather on such bases as legendary tales, than sober historic records; and the result has been error, uncertainty, and confusion. It is to clear these mists and dispel these delusions, that we have undertaken to supply a full and analytical account of the several reports to which we have alluded. We trust that when we have accomplished our task we shall cease to hear and read those clashing statements of what was thought and done in India, which now incessantly distract the public. The profession will possess through the medium of this Journal, the means of comparison, the first accurate data on which to found conclusions respecting the similarity or dissimilarity of the cholera in India, Russia, England. It is idle, it is worse than idle, to waste words in disputation. We have had enough, and more than enough, of this and of assertion; we trust that hereafter we shall find a greater semblance of rigorous deductions from acknowledged facts.
The epidemic which is now upon us, which has invaded others before us, and may attack many hereafter, is certainly anomalous in its characters. Yet we do not ourselves see why the inductive mode of reasoning should not be as applicable to this as to any other malady, nor do we yet forego all hope that because the world has been hitherto unsuccessful in the inquiry, it must necessarily remain so. If men will perversely bar their eyes against all light, or admit it only through one green glass of theory, prejudice, credulity, or subserviency to authority, then the prospects for truth are hopeless indeed. But this is not the inductive method, nor any other that we know of, excepting that of the sheep of Panurgus, who jumped into the sea because their leader fell in. If men will cry out, before they so much
as gain a glimpse of one patient, that cholera is contagious, or absolutely non-contagious, and, if after seeing it they twist all facts to their preconceived opinions, credulously admitting any thing on one side, obstinately denying every thing upon the other, those men are not calculated to advance science or benefit mankind; they are the remnants of the bigots and persecutors of all ages, the mark of the beast is upon them, they are not philosophers but fools, absolutely and unconditionally fools.
The cry, the stupid cry of contagion, in the sense in which it was employed, and the mode in which it was concocted, would have proved, if successful, a curse to the community, a blight to science, a barrier to truth, and a damning stain upon the century. Fortunately it was as futile as foolish. Our minds are yet left open to the impression of facts, and truth may come, without the certainty of the door being slammed in her face, unless she wear the badge and livery of a creed.
There is no more certain mark of a weak mind than prejudice, of a bad mind than virulent party animosity, of a mind at once malignant and petty than the mixture of both. That mixture of weakness and wickedness has been most apparent in the mode of conducting the discussions on the present epidemic. A party of men, determined from the consideration of a certain sort of evidence, to consider the disease highly contagious, were equally determined to hold up all of a contrary opinion as fools or knaves. These modest bigots wondered at the construction of their opponents' minds, just as an Indian may wonder at the constitution of mechanism, which surpasses the tomahawk or fishing-tackle of his own rude hut. It is indeed astonishing with what tenacity poor and sterile minds will cling to opinions hastily embraced. They seem to be much in the situation of a young couple, who having made a love match against all prudential and rational considerations, adore each other with such fury that nothing short of death can effect their separation. It certainly has been thus with the contagionists, and they and their theory were wedded and bedded, in despite of all prayers for reasonable deliberation and delay.
It is the fashion to consider the present age an intellectual one, and possibly it is so. But in proportion as the many display liberality and a disposition to woo and win true knowledge, to seek her as she should be sought, and to use her as she should be used, the few appear anxious to distinguish themselves by an opposite line of conduct. We know but one mode of arriving at truth, and that is by a careful study of facts, and cautious induction from them. We know but one mode of ascertaining facts or of verifying them, and that is by the employment of the eye of sense under the superintendence of the eye of reason. But in this most intellectual nation of a self-styled intellectual age, such a method of study is unblushingly scouted. Our senses are not to be employed, our opinions are to be bought or borrowed second hand from this or that hebdomadal journal. The evidence on which we are to found the most important conclusions is to be drawn from abroad, nay even from particular sources abroad, and the dicta of others are not to be confirmed or confuted by what we ourselves may see. A set of men, some two or twenty, constituted a body, are to decide on what they have never witnessed, are to lay down the law to those who have the means of judging for themselves, and that law is to be received with more submission than any edict of despotism, is to be viewed as
unalterable as the ordinances of the Persians and the Medes. The law being laid down we are thenceforth to become mere passive instruments, automata to move where the wires are pulled. We are not to investigate the phenomena of a malady before us because investigation is a sin, a crime against the majesty of boards, juntas, and journalists. When the disease is in other lands, we are then, and then only, to say what it is, whence it comes, and whither it goes. When it springs up in our own, a change is to come on us. We must hie us from the public places-we must shun all contact with the malady-we must not view it, 'twould be sacrilege; we must not think of it, 'twould be treason; we must not talk of it, 'twould be quackery. We must get us to our closets, and thence we may pen pamphlets or write articles on a disease, which we can only know because we have not seen it. Such has been the impudent and stupid attempt to fetter opinion in this country. That it should miscarry so signally as it has done, was probably not contemplated by those who ventured to essay it. The result might, indeed, have been anticipated by those who can decipher the signs of the times, the impatience of authority not morally just, the prevalence of a spirit of liberality and freedom, mental and political, the diffusion of information, and the enthusiasm of men not chilled by the cold fetters of formal associations. The issue of this very dispute on the contagion of cholera, is to us no mean indication, amidst the many, of the mighty revolution that is yet but begun in the sentiments and manners of men.
To return to our immediate subject. The temper in which we would have men investigate this, as other questions of medical doctrine or medical po lity, should be one of strict impartiality. Let them first procure facts, as far as such can be depended on; and where they fail, let them not, we implore them, fill up the void with prejudice and party-spirit. Let them not, as too many have done, and the bigoted few yet persist in doing, refuse the evidence of their own senses, and receive in preference the bias of theory and the dictates of authority. We repeat that it is to promote this desirable object, by diffusing genuine information and evidence which may safely be relied on, that we have determined to lay before the public the substance of the reports of the medical boards of Indostan. We shall give it in as terse a manner and concise a form as circumstances will permit.
The Bombay Report is drawn up by Messrs. R. Steuart and B. Phillips. It contains a preface of forty-two pages, embodying the conclusions formed by these gentlemen from the reports presented to them, as well as, we presume, from the evidence of their own senses. The remainder of the work is occupied by forty reports, from surgeons who had charge of detachments or hospitals in which the disease broke out. We shall arrange the prominent features of these individual communications in a tabular manner, as we did, in our last Number, with those published by the Madras Board.
The Bombay reporters commence by an extract from Mr. Jukes' letter, describing the first appearance of the disease. When it shewed itself at Jaulnah, it was pretty clear that it would reach Bombay. Passing over a space of 200 or 220 miles, visiting in its course Aurungabad and Ahmednuggur, it reached Seroor, a distance of 150 miles, on the 18th or 19th of July. Towards the latter end of the same month, it appeared in the city of Poonah, though the troops encamped in the neighbourhood remained healthy for some time afterwards.
"On the 6th of August it broke out with great violence at Panwell, a considerable village on the main line of communication between Poona and Bombay, separated from the latter by an arm of the sea, and distant about 15 or 20 miles; but between which a pretty constant communication is kept up by means of boats. On 9th or 10th of the same month the first case appeared on this Island, and, as appears by Doctor Taylor's report, could be traced to a man who had arrived from Panwell the same day; it is also evident by Mr. Jukes's report, that it spread north and south along the sea-coast from the same place, and that it was imported to a village in the neighbourhood of Tannah on the island of Salsett, distant from this place about 20 miles, by a detachment of troops that escorted a state prisoner to that garrison from Panwell. The disease did not break out at Mahim, on the extremity of this island, distant only 5 or 6 miles from the principal native town of Bombay, until it had been established in the latter it then gradually spread over the western side of the island of Salsett, through which the road from Bombay to Surat and the northern countries lies, and by which, during the south-west monsoon, is the principal line of communication. By the observation of some individuals, who, aware of the danger of the malady, and with the humane view of relieving the sufferings which it inevitably produced, carefully watched its progress, we are enabled to trace the disease as if creeping along from village to village on that island precisely in the same way, that is, by the arrival of people affected with the disease from places where it was known to prevail; and we are assured that there are some small villages on that island, which from want of this sort of communication, or from some other cause, have, after a lapse of four months, hitherto escaped entirely." xi.
The Board conclude that the epidemic cholera differs from all other epidemics, and may be said to stand alone. It prevailed in temperatures varying from 40° Fahr. to 90 or 100, during incessant rain, and that arid state of atmosphere that leaves not a trace of vegetation. The Board also think the disease" capable of being transported from one place to another, as in cases of ordinary infection or contagion, and that it possesses the power of propagating itself by the same means that acknowledged contagions do, subject, however, to particular laws, with which we may never become acquainted." This exception rather eats than proves the rule. The Board are aware of the doubtful nature of the ground on which they tread,” and, therefore, mention some facts, with the view, we suppose, of supporting their opinions.
"In October last, when the disease had almost disappeared at Tannah, the attention of Mr. Jukes was called to a case that had appeared in one of the apartments of the barracks of that fort, appropriated to European troops; this, owing to too late application for medical aid, soon terminated fatally; another case occurred a few hours afterwards, the subject of which was saved with much difficulty and danger, and in the course of 6 succeeding days, no less than 9 cases occurred in the same apartment. The curiosity of Mr. Jukes was naturally excited, to ascertain under what circumstances so much disease was produced, and on examination, the ward appeared to be both badly ventilated and too much crowded with men, the place was immediately emptied, scoured, and fumigated, after which no other case occurred. Since the middle of December, when we had flattered ourselves that the disease was vanishing, as the cold season ad. vanced, the number of cases considerably encreased in this Island, Salsett and the Conkan, and consequently excited much alarm; in some instances these cases have been confined to particular spots, and sometimes to particular houses, where the disease has attacked and destroyed in succession whole families, consisting of three, four, and five persons, while in others only a single case, or at most very few have occurred. We are utterly ignorant of any local circumstances to