Quarterly report of the Edinburgh Surgical Hospital from August to November 1829 / by James Syme.

  • Syme, James, 1799-1870.
Date:
[1829]
Catalogue details

Licence: Public Domain Mark

Credit: Quarterly report of the Edinburgh Surgical Hospital from August to November 1829 / by James Syme. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    lip. But it is well known that when a, part is much swelled, a large portion may be taken away without diminishing its na- tural extent; and this is just what had happened in the case under consideration. The lip, properly speaking, was complete- ly wanting, so that the teeth and gum appeared through the breach. The loss of substance had not been repaired. A per- pendicular cicatrix denoted that the lower part of the wound had been closed by the union of its edges. The patient was unable to retain his saliva, and the skin of the chin, which had been drawn up to supply the lip in part, and which had been taken for the product of regeneration, was covered with its cha- racteristic beard. The great breach caused by the operation had been in some measure closed by contraction, but not one particle of the lost substance had been regenerated.” If this be the true account of the lip, I certainly feel inclin- ed to agree with M. Fabre, that the “ well formed proportioned glans,” which Mr Jamieson of Kelso had the pleasure of seeing reproduced after “ amputating the Balanus, preputium, and a small portion of the corpora cavernosa penis,” was nothing more out of the ordinary course of nature than the original glans it- self, which had been concealed from sight by the swelled and gangrenous prepuce. If the alleged reproduction admits of this explanation, in regard to the lip and glans penis, it is evident that we should pay little attention to the evidence afforded by the separation of sloughs from the tongue, where it is so difficult to ascertain the extent of destruction and also of restoration, owing to the great extensibility of the tissue composing this organ. As to the filling up of abscesses, it ought to be recollected that the cavity which contains the pus is not formed by the destruction of any tissue, but by distension of the skin and sub- jacent organs, whence evacuation of the fluid is followed im- mediately by such collapse and approximation of the surround- ing parts as nearly obliterates the hollow. And where there is really a destruction of cellular substance, as in the abscesses of weakly children, a permanent depression remains after the cure is completed. Sinuses are healed on the same principle, viz. by coalescence of the sides ; and every attentive practitioner must have observed the great advantage of laying them to- gether by means of proper bandages, so soon as they are dis- posed to unite. Lastly, as to the healing of ulcers or wounds attended with loss of substance, it is well known that the resulting cicatrix is always smaller than the original sore; and that there is inva- riably a depression of it proportioned to the destruction of parts. M. Fabre quotes the case of a wound in the thigh destroying