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THE experience of the last few years has proved, that the thirst for knowledge which is spreading so rapidly over the civilized globe, and into every corner of society, has been fully felt throughout the medical profession, and that this thirst, which was formerly satisfied with monthly or quarterly supplies, now requires to be gratified at much shorter intervals. It is more than probable that, in future, the Weekly Medical Press will have both the most immediate and the most extended influence; and it is of great importance to the Medical Profession directly, and to the Public indirectly, that it should be conducted with the utmost degree of judgment, knowledge, and good feeling. These are the qualities with which we have framed the ideal model which we shall endeavour to imitate, and although we shall, of course, fall far short of it, it shall not be for want either of wishes or exertions.
In the composition of our paper, we shall endeavour to make our readers acquainted with all that is going on, whether scientifically interesting or practically useful, in medicine, surgery, and the collateral sciences. Each number will generally consist of the following ma
First, A Leading Article relating to topics of particular interest at the time, and which are constantly occurring in a busy and important profession like ours: such are at the present moment the state of medical education in England, the powers and constitution of the College of Physicians, the state of lunatic asylums generally, and those for paupers in particular. Secondly, Original Papers, in the form of lectures or essays. Thirdly, Analyses of valuable Books, both English and Foreign. In this corner of our paper our readers will find concise yet full analyses of instructive books, with which all of us ought to be acquainted, and yet which most of us, when involved in practice, have no time to peruse -stripped of dedications, prefaces, introductions, and all those superfluities with which authors dress up and often bury the valuable matter
which they have to communicate. This part of our paper will thus form a Bibliotheca of valuable works on medicine, which for all ordinary purposes will save the reader the trouble of wading through the volumes themselves. But it is not our intention to fill our pages with severe reviews of worthless productions, which only afford food for satire, and which are better left to sink into silent obscurity. During a scarcity of recent books worth noticing, we shall sometimes become retrospective, and analyse works of great value, which, although long published, are but little known. Fourthly, We shall be regularly supplied with the Scientific Journals, foreign and domestic, from which we shall select those particulars which we think likely to be interesting or useful to medical men. Fifthly, We shall have a head for Miscellanies, which we shall fill with those scraps of curious information which are too good to be lost, but which come under no other denomination. Sixthly, We shall give periodical Reports of what is going on in the principal Hospitals, not only of London, but elsewhere. In these reports we shall keep two rules in view-never to relate cases at full length, unless they are of suffi cient interest to merit it, and always to endeavour to be scrupulously accurate; as it is but too well known that many of those with which the profession has lately been supplied are full of trivialities and falsehoods: the latter often to be traced to more unworthy causes than unintentional These are the materials of which our paper will consist; they seem to comprehend every thing which can be useful or interesting to a scientific medical man; they admit of being executed with various degrees of excellence; and the value of our paper will depend on that which we are able to attain.
At no distant period the profession of medicine was a respectable, peace. ful, and comparatively happy pursuit ; none of its members were exposed to attacks from the press, but those who invited them by the act of publication; the rest followed their occupations in privacy, with no other interruption to their tranquillity than the toils and anxieties of their profession: To industrious and conscientious men, these were enough, and often more than enough, and many a one broke down under them.
But a few years ago a set of literary plunderers broke in on the peace and quiet of our profession. Lecturers who had spent their lives in collecting knowledge, arranging it for communication, and acquiring the difficult art of oral instruction, saw the produce of their lives suddenly snatched from them, and published for the profit of others, with the additional mortification of finding what they had taken so much pains with, disfigured by bad English and ridiculous or mischievous blunders. Whoever attempted to arrest these piracies became the object of furious and unrelenting abuse. Hospital physicians and surgeons, who have to prescribe and operate in public, and at stated times, in whatever condition of bodily health or mental feeling they may happen to be, and exercising in the face of critics not always competent to decide on their merits, a science so avowedly imperfect as to afford abundant scope for uncandid and ill-natured remarks, however judiciously practised,-were
held up to public scorn for errors to which, even if actually committed, the ablest men are occasionally liable, while those who leagued in secret with their calumniators, and who, with one or two exceptions, were as insignificant in station and talents as they were equivocal in character, were represented as at the summit of science and professional eminence. Such, among others, have been the results of a system which has no parallel in the records of any liberal profession. We do not deny that public exposure may have, in some few instances, done good; it may have abolished some foolish custom, or led to the reformation of some trifling abuse; but weigh the evil against the good-it has deprived eminent men of their intellectual property, and destroyed the mutual confidence between pupils and their teachers; it has lowered the respectability of the profession, and has spread general distrust; it has broken up private friendships; it has placed man in hostility to man; and has set so many bad passions into ferment, that well-disposed men become disgusted with the state of their profession, and vow that they never will inflict it on their sons.
We have often heard it said, that no weekly medical paper will succeed which is not seasoned with personal abuse; in other words, that it is impossible to excite the attention of mankind without gratifying some of their worst passions. We do not believe this, and shall certainly not act on that principle. There will, indeed, be times when we shall be compelled, as the determined opponents of every real abuse, to make remarks necessarily disagreeable to individuals; when men of popular talents and eminent station are disseminating opinions or acting on principles practically mischievous, we shall do all in our power to obviate the evil; we shall, however, always endeavour rather to attract attention by the selection of what is interesting and useful, and therefore praiseworthy. Whether our experiment will succeed, time only can tell; but we refer the decision of this question to those members of our profession who have its respectability at heart; who love it as a scientific pursuit; who cultivate it as an art which alleviates human suffering, and often saves human life, and, consequently, as an honourable source of maintenance and respectability in society; who wish to see it followed and practised with philosophic views, and gentlemanlike feelings; that is, we sincerely believe we appeal to the vast majority of the medical profession.
DISEASES OF THE URETHRA, BLADDER, AND PROSTATE GLAND.
BY B. C. BRODIE, F.R.S.
As delivered by him in his Surgical Lectures,
In this and the following lectures, it is my intention to lay before you the results of my experience in the diseases of the urethra, bladder, and prostate gland, The subject is one of the most important in surgery; and ought, therefore, to be regarded as having the strongest claims to your earnest attention.
These diseases are always a source of great uneasiness to the patient; and not unfrequently, when allowed to run their own course, they lead to his destruction, At the same time, there are no cases in which we are, on the whole, able to render the patient more essential service; often by removing the disease altogether, at other times by relieving the more distressing and dangerous symptoms.
I shall consider the subject under the following heads: 1st. Diseases of the Urethra. 2. Those of the Prostate Gland. 3. Those of the Bladder.
Of the Diseases of the Urethra.-The urethra, in the male, as you well know, is long, narrow, complicated in structure, as well as in function. You will not wonder, therefore, that it is liable to more numerous, as well as to more serious diseases than the short, wide, and simple urethra of the female. Of the diseases of the latter, a very few words will sum up what I know, while those of the former will require a more minute investigation. First, then, of the male urethra.
A healthy man, we shall say, voids his urine to-day in a full stream. On the morrow, perhaps, he is exposed to cold and damp, or, what is a still more common cause, he dines out, and forgets, amid the company of friends, the quantity of champaigne, or punch, or other liquor, containing a combination of alcohol with a vegetable acid, which he has drunk. The next morning he finds he is unable to pass his water. If you send him to bed, apply warmth, and give him Dover's powder: it may be, that, in the course of a few hours, his urine begins to flow, and that on the following day, he makes water in as large a stream as before. Suppose you are called to another patient; he tells you that, for many
hours, he has voided scarcely any urine. You feel the bladder, like a large ball, distended above the pubes. He strains to relieve himself, but, with all his efforts, a few drops only of urine pass. You introduce a bougie, and find that it meets with an obstruction, in what is termed the membranous part of the urethra. Withdraw this bougie, and introduce another, armed with the nitrate of silver; and it will often happen, that, in a few seconds after the application of the caustic, the urine flows freely. Again, in another such case, you introduce a common bougie of a full size; press it firmly against the obstruction for several minutes, and the same result follows,-the patient beginning to make water in a
Now in these and similar cases where the difficulty of voiding the urine comes on suddenly, and subsides in a similar manner, we must presume that the cause of the difficulty is temporary, and not
We find, moreover, that in these cases, the obstruction is invariably at one point of the urethra, viz. at its membranous portion; and here you remember there are muscular fibres, which the late Mr. Wilson* particularly described, surrounding and looping up the canal. It is clear that a spasmodic action of these muscular fibres must obstruct the passage of the urine; and to prove that such an action may exist, I have but to state the analogy of the sphincter ani, which you know is often irritated to spasmodic contraction. From the suddenness of the attack, the speediness of the relief, from the anatomy and function of the part, and from analogy, I think it is fair to call this species of stricture, the spasmodic stricture; at least, the phenomena appear to me to be best explained by such an hypothesis, and not to be very explicable on any other.
In another, and a much more common series of cases, you will observe, that the various histories will in essential circumstances run thus. The patient voids his urine in a diminished stream; and this diminution has been going on slowly and almost imperceptibly for months; nay, not unfrequently for years, and now the stream is scarcely bigger than a thread. Should he die, and an opportu
See Mr. Wilson's excellent paper in the first volume of the Medico-Chirurgical Transactions.Ed.