a lot where they had access to salt, meadow-grass, and were compelled to drink of the following mixture, which Dr. Harris had prescribed as an experimental remedy:

"Carbolic acid 12 oz. in crystals, glycerine 4 oz., bicarbonate of soda 12 oz.; mix. Directions.-Dissolve or mix one ounce in three or four gallons of water."

This was readily drunk by the steers. The surface of the ground was liberally sprinkled with heavy oil of coal tar mixed with sawdust. On the 16th one of the five was slaughtered for scientific investigation; the others appeared to be convalescent.

In concluding our review of this report we must again express the satisfaction which its perusal has given us, and the interest with which we anticipate the further communications which are promised with regard to the Texas disease, and our congratulations on the success which has attended the scientific as well as the hygienic labours of the New York Board of Health.

III. Deroubaix on Urogenital Fistula.'

THERE are few, if any, of the ills to which flesh is heir to which can compare with vesico-vaginal fistula in the distress which they cause. The subject of it is not only compelled to bear an ever-present bodily torture from the disease itself, but she has to endure the further, and perhaps greater, misery of being cut off from society and family ties, without even having, as Dieffenbach remarks, the melancholy consolation of being able to hope that a speedy death will deliver her from so much suffering; and it is painful to think how long this malady was the "opprobium chirurgicale," and how numerous must have been the women who went unrelieved to their graves, whose cases were perfectly amenable to treatment.

An account of the many futile methods which have been proposed and practised for its cure forms a curious chapter in the history of medicine-all the more remarkable from the sequel to the story, which shows how completely the disease, with rare exceptions, is now under control.

The work before us is a most elaborate monograph on the subject, so lengthy and diffuse, that it is unlikely that many of our readers will find time and opportunity to make themselves acquainted with its contents. Its chief fault, indeed, lies in its

Traité des Fistules Uro-Génitales de la Femme. Par L. DEROUBAIX, Chiru gien des Hôpitaux Civiles de Bruxelles, &c. Bruxelles, 1870.

excessive length; and it requires no ordinary amount of literary padding to fill upwards of 800 large and closely-printed pages with a discussion of this one disease.

There is, however, a vast amount of labour and research expended in its composition; and it may not be uninteresting to our readers if we extract some of the chief facts in connection with the history of vesico-vaginal fistula, and the many endeavours which have been made at discovering a method of

cure.

It is somewhat remarkable that in the works of the fathers of medicine, whether Greek, Roman, or Arabian, no mention is made of vesico-vaginal fistula. Many of the ancient writers were such accurate observers, that this omission seems difficult to account for. It may partly be explained, doubtless, by the fact that the practice of midwifery was almost exclusively in the hands of women, and that men rarely occupied themselves with it at all. However this may be, it is beyond question that no clear description of the affection is met with until the year 1597, when Felix Plater gives a distinct account of it, and the same was subsequently done by Louis Mercatus, an eminent Spanish physician, and numerous other writers. These authors, however, contented themselves with a description of the malady, its mode of production, and its lamentable results; and none of them seem even to have considered the possibility of attempting a cure. To Van Roonhuysen, a Dutch practitioner, belongs incontestably the credit of suggesting an operation for the closure of the fistula, which has the merit of containing the germs of the method now in use. He proposed that the patient should be laid on her back in the lithotomy position, that the vagina should be largely dilated with a suitable instrument, that the edges of the fistula should be pared with a bistoury or scissors, and that the raw surfaces should be brought into apposition by pins of swan-quill, and dressed with various balsams. It will be observed that this procedure is in many respects curiously like the one at present employed.

It seems doubtful whether Roonhuysen ever practised this operation, or whether it was merely a theoretical proposal. Whether he actually performed it or not is of secondary importance, since to him belongs the undoubted merit of first recommending it. Roonhuysen's name is best known in this country in connection with the invention of the vectis, to which he can only lay a doubtful claim, as it is thought by many that he borrowed the idea from the Chamberlens. The originality, however, of his suggestion, with regard to vesico-vaginal fistula, is beyond any question, and is well worthy of remembrance, since he was the first to point out the direction in which it was

necessary to work, in order to arrive at a reliable method of curing one of the most disgusting of human infirmities.

It is a strange fact in the history of surgery that nearly two centuries elapsed before the hint given by him was practically worked out. Whether it was that his writings were not widely known, or that surgeons deemed his proposal too difficult to carry into practice, it is certain that the seed thus sown took no root. So little, indeed, was thought of Roonhuysen's writings, that Velthem, who wrote an elaborate thesis on the subject in 1724, which professes to contain a complete history of all that had been written with regard to it, does not even mention his name, although he proves his familiarity with Dutch literature by quoting the writings of Ruysch, the anatomist.

During the whole of the eighteenth century few or no attempts at cure were made, and the affection was generally considered beyond the power of treatment. It was not until nearly the end of last century that a new era in the history of the complaint arose, and, owing chiefly to the writings of Desault, numerous attempts at cure were made. His efforts indeed, were based on an evidently fallacious analogy between the urinary fistulæ of the male and the female; but still they had the effect of reviving an interest in the subject. The chief features in his method were 1st. To prevent the passage of the urine into the vagina by keeping a catheter in the urethra. 2ndly. To maintain the edges of the aperture in apposition by suitable plugs in the vagina. Neither of these ideas were new. They had been tried by Velthem, Mauriceau, Levret, and others; but Desault devoted so much care and attention to their application as almost to justify us in considering him as the parent of the practice. His catheter was of large size, and attached to a kind of framework fixed above the pubes, and his plugs were cylindrical and covered with some waterproof material, and were intended, not only to press together the lips of the fistula, but to occlude the vagina, so as completely to prevent the passage of the urine. By these means he affirmed that he had cured several cases of long standing. The value of Desault's method was at first pretty generally admitted, not only in France, but in our own country, where such men as Clarke, Guthrie, and Blundell adopted it. It is very doubtful, however, if there were many reliable cases of cure resulting from its use. Soon a reaction against it arose, and many were found not only to deny its efficacy, but violently to oppose it, and among these the most prominent were Vidal de Cassis, Jeanselme, and Jobert de Lamballe. Jeanselme stoutly contested the supposed fact that a plug would keep together the edges of the aperture, and, to prove this, adopted the ingenious device of using plugs of soft wax.

A cylinder made of this material was passed into the vagina, and on it an impress of the opening was taken. The edges, he said, were always found to be apart.

The frequent failure of Desault's plan caused Naegelé, and after him many German surgeons, to resort to Roonhuysen's original proposal, and attempt the reunion of the edges of the fistula. Numerous plans were proposed, some of which showed considerable ingenuity, but, as might be expected in the absence of a proper speculum, by which the seat of the disease could be exposed, they were all more or less failures. It was, in very deed, working in the dark, and that under circumstances in which extreme accuracy was of essential importance. The cures -if cures there were-must have unquestionably been more the result of good luck than of good management.

Many attempts at cure were made about this time by means of cauterization of the edges of the fistula, and several eminent surgeons, notably Dupuytren, Lallemand, and Delpech, worked assiduously in this direction. Their hope was that the edges of the fistula, swollen by inflammatory action, might permanently adhere, or failing that, that cauterization might produce a narrowing of the aperture, which being increased by subsequent operations, might finally result in complete closure. The agents chiefly employed were nitrate of silver and the actual cautery, the latter being applied with the aid of a properly constructed speculum. Lallemand invented an ingenious method of treatment combining cauterisation with mechanical opposition of the edges of the fistula, which was at one time in considerable vogue. He applied the cautery, nitrate of silver being the one preferred, freely to the edges of the fistula, and after the eschar had separated, and the edges were raw, he introduced an instrument into the bladder, which was intended to seize them and keep them in apposition until adhesion took place. Although these methods had many followers, the reliable cases of cure have been very few indeed, and even those which have been published have been doubted by the opponents of the plan.

It would be useless and unprofitable to refer to all the suggestions and methods of treatment subsequently proposed by various surgeons, and it is the less necessary as they are all now happily more interesting from an historical than a practical point of view. Reference need only be made to one or two authors, and prominent among them is Le Roy D'Etoilles, who wrote an claborate paper on the subject in 1842. D'Etoilles had no favourite method of his own, but endeavoured to gather together all the best points from the plans previously proposed. Being a man of great mechanical skill, he invented a number of instruments, some of them extremely ingenious, and to which we now

refer, because it is not impossible that operators consulting his descriptions might yet obtain useful hints We have no evidence, however, that all this ingenuity had much effect in curing the disease.

Dieffenbach, and Wützer of Bonn, should be mentioned among the surgeons who worked assiduously at the subject, and attempted the cure of vesico-vaginal fistula by means of the suture. The latter, indeed, was so persevering that he is reported to have operated as often as thirty-three times on the same patient, but with a success that could scarcely be called encouraging. A precaution taken by him is worthy of notice. With the view of preventing the urine from passing over and irritating the wound, he performed supra-pubic puncture of the bladder, placing a sound in the opening, and keeping the patient lying on her face.

About this time our own surgeons were strangely indifferent to the operation, and little or nothing was done in this country with regard to it. This is the more remarkable, as of late years so much has been done by us in improving the methods of treating the affection. Indeed, even so late as 1852 in Miller's Surgery,' then a standard work, the cure of vesico-vaginal fistula is stated to be a hopeless task, and the advice given is to trust chiefly to palliatives.

About this time Vidal de Cassis proposed an operation for the cure of the complaint. His plan was to effect complete occlusion of the vagina, the cavity of which should form a sort of supplementary bladder, the urine and menstrual fluid being evacuated per urethram. The merits and demerits of this proposal gave rise to great discussion. On the one hand it was said that the menstrual fluid being retained might give rise to accidents, that calculi might readily be formed in the occluded vagina, that the urine might pass backwards through the uterus and Fallopian tubes into the cavity of the peritoneum, giving rise to very dangerous symptoms, and lastly, that by this method the important functions of reproduction were prevented. On the other hand, these objections were made light of, and the discussion was carried on with much vigour both in the Academy of France and the medical journals.

Jobert de Lamballe, Velpeau, and other French surgeons made, about this time, numerous endeavours to cure the fistula by plastic operations of a somewhat elaborate character, flaps being taken from some part of the vagina and implanted over the aperture. These proceedings gave rise, at first, to great hopes, but they eventually shared the fate of the methods they had followed, and the affection, remained as little amenable to treatment as before.