Correspondence. November, 1850.-Edinburgh: ‘Y
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669 to the Royal Infirmary, Edinburgh.-38, Charlotte-square, Correspondence. November, 1850.-Edinburgh: ‘Y. H. Lizars. London : S. Highley." "Audi alteram partem." The cases here referred to did not mention the names of the patients, or those of the practitioners in whose hands they MR. SYME AND HIS ASSAILANT. occurred, nor did they present any features by which they could be as been under [LETTERS AND DOCUMENTS FROM MR. SYME.] recognised by myself having my care;. as were said to have been treated what the. To the ECZ2C09’ LANCET. but, they by Of THE author chose to designate "a pure pe2-i?z(val sectionist," the SiR,-Having recommended a plan of treating strictures of inference obviously intended was, that they were specimens of the urethra which resist other means of remedy, and believing my practice. They contained the most frightful statements that this proposal was calculated to afford relief under circum- of the dreadful effects, immediate and remote, of the opera- stances the most serious, I felt not only disposed, but in some tion which I had recommended, and, if accepted as trust- measure bound, to maintain it against unjust opposition. My worthy, could not fail to impede its adoption. Had this pub- treatise on this subject was no sooner announced than the lication been limited to Scotland, where the history, character, following advertisement appeared in the newspapers :- and position of Mr. Lizars are sufficiently well known, it could not have done but to more distant readers "In the and will be Practical any harm; place press, immediately published, an with in this I wrote the upon equality my countrymen respect, Observations on Stricture of Urethra, and Fistula in the letter been refused insertion where it had with illustrative of these and of which-having Perineo, drawings affections, a claim-was allowed to in that the preferable kindly appear your the Operation of Catheterism; proving treatment of columns. such diseases can be effected the only safely by employment In to this statement Mr. Lizars has alluded to the of the as out in his of Practical reply Catheter, pointed System that a of one he was second 416. John late fact, twenty years ago, by majority vote, Surgery, edition, page By Lizars, Professor of to the of Professor of to the of and appointed Surgery College Surgeons; Surgery Royal College Surgeons, but as this transaction aff’ects the credit of the much Senior to the Infirmary, Edinburgh." college Operating Surgeon Royal more than the present question, I leave the surviving members The work thus promised more than twelve months ago has of that body to explain the circumstances which led to a; never appeared, but was lately again announced in the follow- choice so extraordinary. In regard to the verdict against him ing terms:- for falsehood and calumny, Mr. Lizars says, " The decision of " In the press, and immediately will be published, Practical a court of law, where proof of the truth libelled is disallowed, Observations on Stricture of the Urethra and Fistula in affords no evidence of moral falsehood;" the inference being, Perineo, with cases and drawings illustrative of these affec- of course, that, if allowed to do so, he could have proved the tions, proving that the treatment of such diseases can only be truth of his statement. But surely Mr. Lizars must have safely effected by the employment of the Silver Catheter, and forgotten that I have in my possession a letter to me in which that all other means resorted to for their removal, not except- he admits that there were no grounds for this statement, and ing the hazardous operation of Perinaeal Section, have failed, as expresses his " sincere regret" for having made it. clearly established by cases published in the Medical Times of It turns out that the first case related bv Mr. Lizars is one 26th Oct., 1850. By John Lizars, late Professor of Surgery to of those contained in my treatise, and I have to beg that you the Royal College of Surgeons, and Senior Operating Surgeon will allow the two accounts to appear side by side. ,},fr. Lizars’ Case of E. 2’L% Mir. Syme’s Case of E..111-. 15th November, 1849.-E. M., aged forty-one, states, that E. M., aged forty-one, a plasterer, was admitted into the about twenty-years ago he fell from a. scaffold eleven feet Royal Infirmary on the 13th of November last, on account of high, and struck his perinseum on a plank, causing great loss urinary irritation, and inability to pass his urine, through the of blood, which flowed freely from the urethra. After this natural channel. He stated, that about nineteen years ago he accident he began to experience difficulty in passing his had fallen across a beam of wood, and bruised his perinasum, urine, which gradually increased, and ended in stricture. In which injury was accompanied by a slight discharge of blood 1841 he applied to Professor Lizars, who put him in a warm from the urethra, and, for a few days, by retention of urine, bath, where, after remaining half an hour, he succeeded in requiring the catheter to be introduced. A small induration inserting No. 2 silver catheter, which was retained for several gradually formed in the periuseum, behind the scrotum, and hours, when No. 3 was inserted. The catheters were increased about seven years ago he had again retention for several days. in size to No. 5, when the patient, considering himself cured, Three years since he suffered from a similar attack, and sub- left off his attendance. sequently has experienced more or less difficulty and pain in In 1848, finding the stricture as bad as ever, the patient passing urine, with enlargement and increased uneasiness of consulted a pure perinoeal sectionist, who succeeded in inserting the perinceal swelling. More recently he was admitted into No. 3 catheter, but after several trials to insert a larger the hospital under the care of the late senior ordinary sur- catheter, he could never succeed; he therefore resolved upon geon (Dr. Duncan), for relief from stricture of the urethra. performing the operation of perinasal section. The patient Bougies were passed regularly, and under this treatment the was placed on the table, as in lithotomy, a staff inserted, and hardness in the perinaeum nearly disappeared. After a resi- an incision made from the most depending portion of the dence of five weeks, he was dismissed almost quite well. Soon scrotum to the verge of the anus, through the skin, cellular after leaving the hospital, he was exposed to cold and wet, tissue, and urethra. The staff was now withdrawn, and No. 7 and his complaints returned with increased severity. The catheter inserted. A great quantity of blood was lost during swelling of the perinasum and scrotum enlarged rapidly. An the operation, which lasted upwards of thirteen minutes. abscess formed, and a considerable quantity of matter was Immediately after being placed in bed, haemorrhage recurred evacuated by incision; and in a few days the urine began to to a fearful extent, and was with difficulty suppressed. In escape through the opening thus made. about an hour after, haemorrhage broke out again, and was At the period of his final admission, (13th November, 1848,) stopped. Towards night, bleeding again commenced, and was there was great induration of the permseum and scrotum, checked with great difficulty. The patient states, that by with two fistulous openings about an inch from each other, these repeated losses of blood he was much weakened. through one of which the chief part of his urine escaped. The Fourteen days after the operation, No. 9 catheter was in- patient, from long suffering and disturbance of sleep, which he serted. In three or four months after, No. 8 only could be was not permitted to enjoy for more than a few minutes at a inserted. Soon after the operation, he was attacked with time, was extremely irritable and desponding, and derived no palpitation of the heart, which incapacitated him following benefit from the introduction of instruments through the his occupation and earning his livelihood. stricture, which was situated about five inches from the orifice He also states, that the stricture is as bad as ever; and, of the urethra. on taking off his trowsers to show the cicatrix in the peri- On the 20th, I introduced a grooved staff into the urethra., naeum, he was seized with palpitation of the heart, and com- and cut upon it in the perinseum through the contracted part, pelled to lie down on a sofa for a few minutes. making an incision about two inches in length. A full-sized In March, 1850, he consulted a physician, who gives the catheter was then introduced, and retained in the bladder. following account:-" E- M- is attacked with palpita- The catheter was withdrawn at the end of forty-eight hours, tion of the heart on any exertion, being seized with violent after which the patient did not make a drop of water through pain in the region of the heart, shooting to the left shoulder, the wound, and was at once completely relieved from all his 670 and down the left arm to the fingers, all of which he ascribesprevious sufferings. He quickly regained his sleep, appetite, to the haemorrhage consequent on the operation. He has hadand strength, and was dismissed cured on the 2nd of De- no rheumatism, no inflammation of chest, no difficulty ofcember. breathing or cough, and none of his relations have had any heart disease. He has not been able to work since the opera- tion.