A letter addressed to James Syme, esq., Professor of Clinical Surgery, Edinburgh, in refutation of certain statements made both by him and others, his advocates, in relation to a case of stricture of the urethra, in which the operation of perineal section was performed / by Francis Burdett Courtenay.

  • Courtenay, Francis Burdett, 1811-1886.
Date:
1852
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Licence: Public Domain Mark

Credit: A letter addressed to James Syme, esq., Professor of Clinical Surgery, Edinburgh, in refutation of certain statements made both by him and others, his advocates, in relation to a case of stricture of the urethra, in which the operation of perineal section was performed / by Francis Burdett Courtenay. 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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    The following arc copies of Mr. Syme's letters referred to in the fore- going remarks, and ichich are quoted by Crito Hypercmticus in cor- roboration of his representations: (First Letter.) “In a case, which was sent to me in June, 1849, by Mr. Courtenay from London, and which has been made the most of by him and other opponents of the new operation, the patient described himself, in a letter to me in August, as already so well that his usual medical attendant declared he was ready to recommend his life for assurance if required. The improvement, however, did not prove altogether permanent. Before the end of the year the patient complained of some threatenings, attribu- table to nervous anxiety.* In the following February he had an attack of retention similar to those he had previously experienced.']' Still, so far as could be gathered from himself, his general health has continued better; and the disease, though not removed, has been less troublesome than before the operation. 4 Most thankful,’ writes he the last time I heard from him, in April, 1851, 4 am I to be able to say, I certainly am better than before I went to Edinburgh.’ “ I think the imperfect result of this case, and some others in the early part of my practice, may be attributed to one or both of the following cir- cumstances,—the importance of which I had not ascertained at that time from experience: viz., first, that the strictured part of the urethra may not have been divided freely enough; and secondly, that the precaution of occasionally passing a bougie was not observed long enough. When I introduced an instrument some days after the operation, the patient remarked, that it ‘jumped’ at the seat of contraction, instead of passing smoothly along the whole urethra, as I now always find it do; so that it must have encountered an appreciable, though slight resistance, which a more free division of the urethra might have removed. I supposed at the time that the incision would be sufficient to obviate any tendency to contraction in future ; and I therefore advised the bougie to be laid aside so soon as the wound of the mucous membrane could be considered as fairly healed. J I have been long aware, however, of the possibility of unfavourable results from these two errors ; but, among the cases I have operated on during the last two years, I am not acquainted with a single instance of relapse.” * Yes, and this before Mr. Syme’s book was published: see the patient’s letter dated 8th of October. f Contrast this softened account with the statements referring to the same period, contained in the patient’s letter dated February the 5th, and wherein he mentions having received a letter from Mr. Syme, in which that gentleman said he had not written before “ because he was quite at a loss to account for the state the patient represented, and the best plan to be adopted for relief!” t These reasons cannot apply in this case, as the patient never ceased to introduce the instruments until long after the mucous membrane must have healed.