SURGERY. 727 
peritoneum, for the purpose of discharging the fluid collected 
there in dropsical cases. Modern practitioners usually pre¬ 
fer making the puncture in the linea alba. 
When the operation is to be performed in the linea alba, 
the instrument should be introduced about two or three 
inches below the navel. 
As soon as the trocar meets with no further resistance, it is 
not to be pushed more deeply without any object, and with 
a possibility of injuring the viscera. The stilet is now to be 
withdrawn, and the fluid allowed to escape through the 
cannula. Since, in consequence of the sudden removal of 
the pressure of the fluid from the viscera and diaphragm, 
patients are very apt to swoon. The abdomen is to be 
compressed with a bandage or belt. 
An operation for aneurism of the aorta, was performed 
some years ago by Sir A. Cooper; but the patient died, and 
the apparent hopelessness of this sort of case is such, that no 
surgeon has followed his example. The following account 
of the operation is extracted from that gentleman’s Surgical 
Essays:— 
“ The patient’s shoulders were slightly elevated by pillows, 
in order to relax as much as possible, the abdominal muscles; 
for I expected that a protrusion of the intestines would pro¬ 
duce embarrassment in the operation, and was greatly grati¬ 
fied to find that this was prevented by their empty state, in 
consequence of the involuntary evacuation of the faeces; and 
here let me remark that I should, in a similar operation, con¬ 
sider it absolutely necessary, previously to empty the bowels 
by active aperient medicines. 
“ I then made an incision three inches long into the linea 
alba, giving it a slight curve to avoid the umbilicus: one 
inch and a half was above, and the remainder below the 
navel, and the inclination of the incision was to the left side 
of the umbilicus in this form ( b ). Having divided the 
linea alba, I made a small aperture into the peritoneum, and 
introduced my finger into the abdomen ; and then with a 
probe-pointed bistoury, enlarged the opening into the peri¬ 
toneum to nearly the same extent as that of the external 
wound. Neither the omentum nor intestines protruded; 
and during the progress of the operation, only one small 
convolution projected beyond the wound. 
“Having made a sufficient opening to admit my finger in¬ 
to the abdomen, I then passed it between the intestines to the 
spine, and felt the aorta greatly enlarged, and beating with 
excessive force. By means of my finger nail, I scratched 
through the peritoneum on the left side of the aorta, and 
then gently moving my finger from side to side, gradually 
passed it between the aorta and spine, and again penetrated 
the peritoneum on the right side of the aorta. 
“ I had now my finger under the artery, and by its side, I 
conveyed the blunt aneurismal needle armed with a single 
ligature behind it; and my apprentice, Mr. Key, drew the 
ligature from the eye of the needle to the external wound; 
after which the needle was immediately withdrawn. 
“The next circumstance, which required considerable 
care, was the exclusion of the intestine from the ligature, 
the ends of which were brought together at the wound, and 
the finger was carried down between them, so as to remove 
every portion of the intestine from between the threads: the 
ligature was then tied, and its ends were left hanging from 
the wound. The omentum was drawn behind the opening 
as far as the ligature would admit, so as to facilitate adhe¬ 
sion ; and the edges of the wound were brought together 
by means of a quilled suture and adhesive plaister.” 
Of the Pelvis. 
The surgical diseases of the pelvis, besides inflammations 
(which are of course common to the contents of this cavity 
as well as all other parts,) are such as affect the urethra, 
bladder and prostate gland, diseases of the rectum, and in 
females diseases of the vagina and uterus. Of the last, we 
have spoken fully under Parturition ; of the second, 
under Pathology. We have therefore only to give some 
account of the first. We shall speak of diseases of the mucous 
membranes in the first instance, and of the external parts 
and general structures afterwards. 
The ureters, the bladder, and the urethra, are all liable 
to be affected with catarrhal affections from general causes, 
the same as other mucous membranes. 
The catarrh of the bladder is more frequent among men 
than among women; and old people are more subject to 
it, than those at any other period of life. 
This disease is marked by pains of the bladder, and at the 
point of the urethra, both before, and whilst making water. 
The injection of the urethra is more or less difficult, accord¬ 
ing to the action of the bladder, and of the freedom of the 
passage of the urethra. The hypogastric region is tense, and 
the urine presents a variety of colours; it is sometimes whitish, 
or reddish, or of a deep yellow colour; it is muddy, and 
it exhales an odour of ammonia, which becomes more 
sensible a short time after it has cooled. It also forms, in 
most common cases, a mucus, which mixes and comes 
away with the urine in the form of glairy filaments, and 
which is afterwards deposited at the bottom of the vessel, 
in the form of the tenacious glairy substance, resembling 
somewhat the white of an egg. 
The chronic inflammation of the mucous membrane of the 
bladder, may be accompanied with an ulceration of the 
kidneys or bladder; the mucus discharged then becomes of 
a greenish yellow colour, sometimes mixed with streaks of 
blood. It is deposited slowly, is mixed easily among the 
urine, and in water; it has little viscidity, or fcetor, and 
does not coagulate by ebullition. The other symptoms 
which accompany this excretion, as fever, pain, wasting of 
the flesh, sufficiently distinguish this double affection of 
the bladder. The chronic catarrh is subject to return 
with intolerant pain in the region of the pubis and perinasum, 
accompanied with restlessness and anxiety. These inter¬ 
missions are irregular, and may remain some weeks. 
The matter which exists in the mucous membrane of the 
bladder, and that of other membranes of the same name, 
is sufficient to point out the means which are to be employed 
in its treatment. The warm bath, and mucilaginous drinks, 
are particularly indicated at the beginning of the acute ca¬ 
tarrh; but the tendency which it has to become chronie 
ought to make us cautious in not prosecuting debilitating 
remedies too far. Opium should be employed with great 
circumspection, notwithstanding the intensity of the pain; 
and as this is often the result of the distension of the bladder, 
from the accumulation of urine, it is sometimes necessary to 
have recourse to the introduction of the catheter. 
This mucous membrane is liable to a very acute form of 
catarrh, induced by specific causes, and called gonorrhoea. 
The first symptom of this complaint is usually an itching 
at the orifice of the urethra, sometimes extending over the 
whole glans penis. A little fulness of the lips of the urethra 
is next observable. Very soon after the discharge has ap¬ 
peared, the itching changes into pain, especially at the time 
of voiding the urine. The penis, and particularly the glans 
are affected with swelling. The latter part has a transparent 
appearance around the mouth of the urethra, the skin seeming 
distended, smooth, and red, like a ripe cherry. Sometimes 
the glans, as well as the beginning of the urethra, are more 
or less excoriated. This canal becomes narrower, as is 
proved by the stream of urine being smaller than common. 
Small swellings are often observable along the lower surface 
of the penis, in the course of the urethra: these were sus¬ 
pected by Mr. Hunter to be the enlarged glans. In some 
instances, also, Cowper’s glans in the perineum inflame 
and suppurate. 
The natural discharge from the urethra is first changed 
from a transparent viscid secretion, to a watery, whitish 
pellucid fluid; and this, becoming gradually thicker, assumes 
the appearance of pus. The matter often changes its colour 
and consistence; sometimes it is almost white; sometimes, 
quite yellow; and, in other instances, greenish. 
In ordinary cases, the affection of the urethra does not 
extend very far along this canal from its orifice. 
Besides 
