Observations on Fungous Excrescences of the Bladder; A Cutting Forceps for Extirpating These Excrescences; And Canula's for Treating These Diseases; By M. Le Cat, F. R. S. Translated from the French by Tho. Stacke, M. D. F. R. S.

XLV Observations on fungous Excrescences of the Bladder; a cutting Forceps for extirpating these Excrescences; and Canula's for treating these Diseases; by M. Le Cat, F. R. S. Translated from the French by Tho. Stacke, M. D. F. R. S. Read Nov 14, 1751. THE widow Néel, a farmer at Pleinbofs, in the parish of Etoutteville near Yvetot, had, for some years, felt pain in the small of the back, thighs, &c. In the year 1734, she had made bloody urine, and had one thigh and leg oedematous. These accidents having disappear'd, were succeeded by worse symptoms. She had frequent calls to make water, and did it often, a little at a time, and with pain, which was violent, particularly after the urine was discharged: and this was of a dull red colour, that is, a little tinged with blood. All those of the profession, whom the patient consulted, assured her that she had the stone; and I was of the same opinion, but would not pronounce positively, till I had search'd her; which I did the 17 of October 1735. As soon as the sound was introduced, blood came away, and in greater quantity, the more I moved it about. The free play of the sound was obstructed: I found no stone, but pretty sure signs of excrescences in the obstruction of the sound, and the issue of blood, which its motion occasioned. However, by dint of management I found a situation of the sound, in which, by giving a little jerk, jerk, I touch'd a hard body, the dull percussion of which convey'd nothing but obscurity to my hand or judgment. In order to come at the knowledge of this body, I pass'd the crooked sound destined for men, the bent of which I thought fitter to favour my inquiries. I found the same body again, but still with the same obscurity. I had extracted stones, which did not afford plainer marks of their existence; wherefore I judged, that there might be a stone and fungous excrescences too in this bladder; and that these excrescences were the obstacles that render'd our search difficult, and the stone doubtful. But the dull resistance which this hard body made, inclined me to think, that it might as well be some scirrhouss tumour. These doubts held us a long time in suspense what party to take: but the extreme pain which the patient suffer'd, and the frequent hæmorrhages, which must soon put an end to her life, made us determine to perform the operation; that is, to open the neck of the bladder, either to extract the stone, if any, or remove and treat the fungus's, which existed beyond all doubt. I cut this widow the 18 of October 1735, by what I call the rural apparatus, that is, without placing her upon the table used in our hospitals, which could not well be carried to the country where this woman dwelt. I placed her on the edge of her bed: a chair turn'd upside down supported her shoulders. Unknown to the patient I caused a board to be put under the first mattras of this edge of the bed: and when she was placed on it, under her backside, or the os sacrum, I laid another board, on which I put a straw cushion made made compact and cover'd with linen-cloth. Two straps tied to the ends of this board were passed into the bars of the turn'd-up chair, which supported the patient's body: and these pieces, to wit, the chair and the board with the cushion were fastened together by buckles that were on the straps. The assistants, who were on each side of the patient, had each a strong large swathing band folded double, and pass'd into this fold in a flip-knot: at present I use one of those strong woollen sashes or girdles, with which couriers bind or swathe their body. This flip-knot was passed on the patient's wrists, who had seen nothing of these preparations, and she was bound fast, almost before she was aware of it. Then I introduced a common grooved staff, such as is used for abscesses of the bladder: I turn'd the groove towards the patient's left thigh, and on this groove I push'd my knife into the bladder; which knife is the same that I still use for women, but made a little narrower. On that knife, which had a groove, I slid the gorget and forceps in the usual manner. I searched for the stone, but in vain, I found nothing but excrescences, one of which was considerably hard: I extracted several clusters of them with the forceps. Yet still I was not very certain, but that there might be a stone behind a rampart of excrescences which I felt; and I had not brought the crooked forceps with me to search behind this intrenchment. When I judged that the patient was fatigued by my searchings, and the extirpations which I made with the forceps; I had her put to bed, after having put a canula into the wound, contrary contrary to my usual custom; but this case required it: these strange bodies were to be removed, if possible; that organ must be injected, and consequently the canula was absolutely necessary. The patient, who bore the operation exceedingly well, was blooded two hours after it: she had a pretty good night, and was blooded again the next morning. I left one of my pupils with her, and return'd to Rouen. The canula, which I left in the wound, was of the common sort, and therefore too narrow to admit of searching in the diseased part, and to give issue to those excrescences, which we ought to endeavour to disengage and bring away in this treatment: besides, it is extremely difficult to make the canula remain in the wound. As soon as I got to Rouen, I order'd the canula (Plate IV. Fig. 1.) to be made; the advantages of which above the old one are: 1. To afford a wider passage for the substances that are to be evacuated and introduced. 2. To secure the instrument in the bladder, by its own structure chiefly, and particularly by the swelling at BB. 3. The neck AA, which is at the basis of the swelling, is embraced by the neck of the bladder; whereby the surgeon may be sure, how much of the canula enters the bladder: and the openings CC, being immediately above the swelling B, are fixed at the lowest part of the bladder. Fig. 2, 3, 4, of the same plate represent the same canula as above described, but with further improvements for cases, which require the evacuation of gross substances, the passage for which cannot be be too wide and direct. The description of its parts, which is in the explanation of the figures, suffices to shew its use. I return'd to the patient the next day; and found her in a fever, with many colicky pains: but at the end of the third day there was nothing extraordinary. I intended to make another search, but I feared renewing those accidents: wherefore I contented myself with injecting a liquid digestive; and deferr'd any farther trials till after the suppuration was well formed, which I expected about the 8th or 9th day. I re-visited the patient on the 7th, and found her a little feverish, but she had a good night's rest. There was a small discharge thro' the canula of tolerably white pus, but of an intolerable smell. The canula seem'd to us to be much clogg'd with sloughs; and the stench made us suspect a collection and lodgment of these sloughs behind the canula. We resolved to put in the canula above described; and as there was a necessity of dilating, in order to introduce it; we agreed to take the advantage of this dilatation, to try to discover by the crooked forceps, which I had brought with me, if there might not be a stone to be extracted, or at least some more of these excrescences, and to break or bruise such as we should not be able to draw, that they may fall off by suppuration. I executed this trial on the 8th day. The dilatation was made between two grooved sounds, as it is done in the greater apparatus between the male and female conductors. I found no stone as yet, but brought away clusters of the tops of fungus's a specimen cimen of which appears in Plate I. Letter F, I crushed the rest of the excrescences, and placed the large canula. Experience has shewn me, that this bruising of the fungus's of the bladder is more painful and dangerous than possibly is imagined. They are far from being of the same nature with the polypus of the nose, which is pull'd out with little or no pain, and without any bad consequence. The fungus's of the bladder have more consistence, more solidity, and for that reason more sensibility. Accordingly, after this last operation, the patient was seized with a violent fever, which carried her off in two days. I open'd her body, and found the bladder in the condition represented by the figures, and their explanation. This observation made me think, that if I met with a parallel case, that is, a patient with fungous excrescences in the bladder, distinctly characterized, and accompanied with pains and excessive haemorrhages, which render the palliative cure useless and unsuccessful; and if he had a constitution and courage proper to make me hope for success from a great operation; I would find a way to attack the excrescences with a cutting instrument, the operations of which are much surer and less painful than any other method. Practitioners advise to suppurate such of these excrescences, as the fingers cannot reach, that is, those which can neither be tied nor cut. But how can one bring such sensible parts to suppuration? we have no ointment that can raise a suppuration in a sound part. Fungus's are a sort of vegetation, which, tho' preternatural, are still living, and, and, in some measure, found parts: how then are they to be disposed to suppurate? it must be either by pulling them out, or by crushing them, as we have done. But seeing this operation is dangerous, an instrument should be contrived, which might be conveyed to the bottom of the bladder, like the forceps; and which might at the same time be able to cut these inaccessible excrescences, or the greatest part of them at least; the remains of which being cut open, would thereby acquire the necessary dispositions to suppurate, which are indicated for the cure. For this purpose it was, that about that time I contrived the cutting forceps of Plate III. the use of which will be sufficiently declared in the explanation of the figures. I did not intend to make this instrument public, until I had used it on a living body: but, as no opportunity has offer'd since the year 1735, I thought I ought not to delay its publication any longer; to the end that, if some other person met with this opportunity before me, he might profit by the reflections, which the preceding observation occasioned me to make. Explanation of the Figures. Plate I. The bladder of the widow Néel, full of excrescences. AAA, The bladder. BB, Its neck. C, The incision of my lateral operation. DD, Thickness of the coats of the bladder. E, Remains of the excrescences, which were not extirpated, and seem round or regular, because their tops tops ending in clusters were taken off by the forceps. F, The shape of these tops of the excrescences. Plate II. The same bladder, after removing the excrescences, in order to shew their common root E. F, Very considerable fleshy fibres, which surround this basis, and were confounded in the scirrhouss substance. It was this scirrhouss basis, that I had touch'd with the staff, and which I took for a hard body. The difficulty of touching it arose from the necessity of passing between two excrescences. DD, The great thickness of this bladder. Plate III. Cutting forceps or scissors, to cut the excrescences of the bladder or uterus, which are inaccessible to the fingers. A, The bend of this instrument on the flat of its blades. B, Buttons, which terminate each blade, and are at some little distance from one another, even when the blades are closed together: that these ends might neither prick nor pinch the coats of the bladder. Plate IV. Fig. i. The new canula. A, The neck, which is to be embraced by the neck of the bladder. B, The swelling, which is to be within the neck of the bladder. C, The head, which is to be in the cavity of this organ, together with its wide openings. D, The style or sound of this canula. Fig. 2. The same canula improved, inasmuch as its end B, which I name introductor, is screw'd on the canula A at C, and is unscrew'd by means of the structure of this introductor. Fig. 3. The introductor separated from the canula. A, A wire or rod of steel, which supports the end of the introductor, and serves to unscrew it from the canula. B, The extremity of the introductor, which ought to be made of silver. CC, Elastic steel plates or blades. These plates have on the inside of their edge a female screw, which enters on a male screw of the outside of the end of the canula. Their springiness makes them separate when the introductor is mounted on the canula; and by this widening asunder they leave the openings or eyes of d, d, Fig. 1, 2. But when they are unscrew'd, they close together, as appears in Fig. 3, whereby this end becomes slender enough to pass thro' the canula, thro' which this part of the instrument is drawn out, when the canula is placed in situation; which is the intent of this structure; for, by this means the outlet becomes larger, and the excrescences cannot be fretted. Fig. 4. The canula stripp'd of the part above described. A, Its funnel or tube and wide straight orifice: wherein consists XLVI. An Account of the Cinnamon-tree, by Mr. W. Watson, F. R. S. To the Royal Society. Gentlemen, Read Nov 21, 1751. I TAKE the liberty of laying before you a specimen of the bark and wood of the cinnamon-tree, nearly of the length and size of an ordinary walking-cane, transmitted from our worthy member Mr. Benjamin Robins, now in India, to Dr. Letherland, who was so obliging as to put it into my hands for your inspection. And, in order to convey to you at the same time a yet more perfect idea of the tree itself, there accompanies it a small branch of this valuable plant from my own bortus ficcus. Cinnamon, in the state now before you, is a great curiosity, and seen in Europe at present extremely seldom. Clusius tells us, that he saw two specimens of it. Anciently indeed it was often brought in this manner, viz. with the bark surrounding the wood; and it is believed by authors of very great credit, that the wood, not divested of its bark, as we now see it, or the bark stripped from the wood, was called by different appellations. And notwithstanding the various controversies, which have arisen in endeavour-