Editorials and Medical Intelligence

1836 Boston Medical and Surgical Journal  
by the profession, and by the sick, in the light of a boon of inestimable price. It will not be disputed that some very rare cases occur, wherein union by the first intention, might, by obstructing the passage of soft calculons material by the wound, expose the patient to a return of the malady. 1 have seen one case in point, in which a doughy calculus escaped with pain and difficulty through the wound on the tenth day, and again a similar discharge on the fifteenth, after the operation ;
more » ... e operation ; corresponding with a similar case described by Sir Astley Cooper in his lectures, as occurring under the charge of one of the surgeons of Guy's Hospital. But these cases an; so rare that they cannot be urged as objections to the practice of healing the bladder as speedily as possible. The mode of accomplishing this should not be misunderstood. It certainly does not depend upon the keen edge of a smooth culling instrument ; upon any direct correspondence between the extent of the wound and the magnitude of the calculus ; nor upon the small number of times the instruments are introduced into the bladder, with a view to extract the stone, so much as upon a prepared state of the general system to institute the healthy process öf reparation ; upon a bland, digestible, abstemious regimen ; upon the position observed during the cure ; and upon continued attention to the regular and healthy performance of the various important functions of the body, throughout the whole period of the confinement. Union by the first intention was effected in eight of the whole number of cases of lithotomy that have been under my care. Six of these had but a single calculus each ; one had two of considerable size, that required unusual efforts to extricate them, and the remaining case, Parson King, had thirteen. No satisfactory reason can be assigned why many other cases, which, so Air as the manifest circumstances are involved, were even more favorable to union by the first intention, have yet had a different termination. The varieties of action, morbid as well as healthy, are like the physiognomy of man, infinite in kind and manner of expression.-Transylvania Med. Journal.
doi:10.1056/nejm183611230151604 fatcat:2chbozkuuvg3hpdd7khebnfbf4