The Harveian lectures on twenty-five years' experience of urinary surgery in England : delivered before the Harveian Society of London / by G. Buckston Browne.

  • Browne, G. Buckston (George Buckston), 1850-1945.
Date:
[1901]
Catalogue details

Licence: In copyright

Credit: The Harveian lectures on twenty-five years' experience of urinary surgery in England : delivered before the Harveian Society of London / by G. Buckston Browne. 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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    early days the great dread of the surgeon, so in urinary surgery fever was the great fear of the operator. And this fear controlled, influenced, and in fact dominated all his movements and all his plans and checked all his enterprise. If he passed a lithotrite or employed a catheter he often found that fever followed, and a fever which not infrequently proved fatal. The surgeon therefore interfered as little as possible with the urinary passages and for many years but little real progress was made. I propose at once to consider the question of urinary fever, for it is at the bottom of the whole of urinary surgery. Whenever you touch urinary surgery you find this fever, and even now its causation and therefore its prevention is very little understood. In all our books you find vague and uncertain statements. I believe this fever to be at its outset purely a suppression of urine, varying from merely transitory to the most complete and absolute, this suppression being due to the inhibition of the action of the kidney from urethral shock. The nerve supply of the urethra is remarkably generous and the penis itself is most intimately connected in this way with the rest of the body. An excellent illustration of the very liberal nerve-supply of the urethra and of its intimate connexion with the rest of the body is afforded by the study of the marvellous phenomena of erection. In the pre- chloroform days many a man has died upon the operating- table simply from the shock of an amputation of the penis. If a bougie is passed upon the average young man in the standing posture he will in many cases in a few moments be writhing on the floor in what is practically an epileptiform con- vulsion ; let him be put to bed, and a good perspiration encouraged, and he will soon be well; but if an old man be subjected to a similar shock he does not always recover. Many surgeons of sufficient experience will be able to recall some case of an elderly man who has had a catheter passed and who has never secreted another drop of urine and has died. In illustration of the effects of shock and of its control by the use of sedatives I well remember a nervous, sensitive, highly-strung young practitioner who came to me with a severe urethral stricture. Tffe gentlest instrumentation was followed by high fever. I fortunately thought of giving him one-sixth of a grain of morphia hypodermically an hour before passing the bougie. This was followed by the happiest results : there was no fever and dilatation was easily proceeded with. Some years ago I had even a more instruc- tive case than this with my old fellow-student Dr. Peter Duncan of Croydon. He called me to a case of an elderly