Remarks on a treatise on the rectum [by James Syme] / [A.W. Cockburn].

  • Cockburn, Archibald William, 1814-1862.
Date:
[1838?]
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on a treatise on the rectum [by James Syme] / [A.W. Cockburn]. Source: Wellcome Collection.

    2/8 (page 2)
    And in the third place, the operator and his assistants are extremely apt to be jostled in a ward, by students crowding around them. We are aware, that in some wards all minor operations, of which fistula is one, are performed in the ward with the doors bolted ; and the gross errors of surgery, and the serious and lamentable mistakes which there occur, and could be named, are of no small number. Professor Syme informs us, that, at the present day, the cure of fistula by the knife “ hardly deserves the serious title of an operation.” Is that not entitled to be called an operation which he himself tells us includes “ difficulty of performance, suffering to the patient, risk of haemorrhage, and the trouble of after-treatment ?” If it is not, his definition of “ an operation” must be curious indeed. He lays down “ a flat and ill-defined swelling, resulting from the presence of the fluid,” as the first circumstance which attracts the at* tention of the patient. “ Coming events cast their shadows before and surely Professor Syme’s patients must be forewarned of their ap¬ proaching evils, or else must be possessed of an uncommon degree of curiosity which prompts them to inspect their anal region, and detect this first appearance of their fistula. The attention of other surgeons’ patients is always drawn at first to the disease by the presence of pain, especially when at stool, or in the sitting posture, long before swelling of any shape is observable externally, although they expe¬ rience equal anxiety about their bodily ailments with Professor Syme’s patients. The swelling occurs when the abscess is formed, not as the first symptom of its formation. The causes of fistula, Professor Syme informs us, act “ either by exciting a predisposing liability to it, or by directly calling it into existence.” We have heard of “ predisposing liability” to pulmonary consumption, diseases of the heart, or other organic derangements, but must confess we never heard of “ predisposing liability” to frac¬ tures of the cranium, luxation of the shoulder, fistula in ano, or most other surgical complaints. He informs us, that the first symptom of phthisis is in general the appearance of a fistula. This is indeed a new fact in the history of phthisis ; and certainly is a simple method of solving any doubts with regard to distinguishing it from any other pulmonary affection. Physicians may now exchange the stethoscope for the silver probe, which will simplify their labours in no small de¬ gree; for, though a few have not accurate ears, mostly all have a due power of vision and touch. We are told, that an ulcerated state of the great intestine is the “ exciting cause of fistula.” Now fistula, according to Professor Syme, is the first symptom of phthisis,—ergo, the great intestine must be in a state of ulceration before any symptom of phthisis makes its appearance ! ! ! The ulceration of the great intestine is the gene¬ ral cause of death in consumptive patients — thus the common cause ol death in that disease, Professor Syme accurately traces to be iden¬ tically the same cause which gives rise to fistula, the first symptom of phthisis. We must confess we have seen a good many cases of fistula, and most of them in robust countrymen, but have neither found phthisis following, nor ulcerated intestine preceding their complaint. In fu-