INJURIES TO THE FEMALE BLADDER.
Urinary Fistula; in the Femak.
We have drawn largely upon his works. In the oldest medical writings we find no indications to show us that the physicians knew anything of urinary fistula. Impartial judges cannot admit the forced interpretation that would impute a reference to this malady to certain passages of Hippocrates. The Arabs wrote much upon incontinentia 'prime, but nothing in reference to fistula. Perhaps these lesions were rarer in ancient times, or went unrecognized, partly because delivery was easier, and partly because men were long debarred by custom from the practise of obstetrics and gynecology. Even much later men held the practise of oestetrics to be infra viri dignitatum. It was only at the end of the 16th and the beginning of the 17th century that we find urinary fistulw mentioned at about the same time by several physi cians; so that it is hard to decide to whom its first recognition is to be ascribed. In any case, however, we must first mention the name of Ludovicus Mercatus, a renowned Spanish physician, who in his work: De communibus mulierunz affectionibus, 1605, devotes a long chapter to " fistulazi of the uterus," and not only describes the symptoms, but proposes a definite operation for their relief. Thus lie says: Prima indicatio, quatenus ad affectum pertinent, docet callum prius conterere; nam cum ea gum disjuncta Bunt, uniri minime possint, callo in medio existente, curandum primo est, eum exstirpare. Orificio satis patulo, callum uno e tribus modis exstirpare poteris: medicamentis nimirum acrioribus et cal lum conterentibus, scissione ac avulsione calli et ultima partis inustione.
Further, Felix Plater in his work which appeared at Basel in 1625: De mulierum partibus generationi dicatis, mentions two cases of tearing of the neck of the bladder in difficult labors, notices the erosions of the vulva which occur with it, and names the remedy to be employed. (Lactis cremor et mucilaginosa). In a Paris thesis of Severinus Pinmus of the year 1597, urinary fistulue are also mentioned. In 1606 Fabricius Hilda nus mentions several noteworthy cases of the affection, and especially described a case in which a large vesical calculus gave rise to such a fis tula. In 1664 Pietro di Marchetis strenuously urged the use of the actual
and the potential cautery for these fistulte, and obtained a complete cure in this way. As early as 1663 Hendrik van Roonhuyzen of Amsterdam had advised stitching for the cure of the affection; but like Mercatus he seems to have left the execution to others. More exact data concerning the malady we are considering are found in J. Varandaeus (1619), Ch. Vtilter (1687), Musitanus (1698), Mauriceau (1712), J. Fatio (1752), A. Levret (1753); and henceforward it is mentioned by almost all writers upon diseases of women and on surgery. But, as Freund says, there is a complete and surprising absence of any description of the malady in the larger pathologico-anatomical works of Morgagni and J. Lieutaud. In fact the pathology of urinary fistula was much neglected until very lately, partly no doubt because the patients were seldom the subject of post mortem examination, and partly because all interest had long been centred upon the therapeutics of the disease. In this latter field the following names are to be noted: Desault, who at the beginning of this century again recommended cauterization, Dupuytren, who repeatedly nsed the red hot iron in 1820 with complete success; Dieffenbach and M. Chelius, Monteggia, Soupart, and Roubaix.
But a new era in the history of the operative cure of this malady was inaugurated by Jobert de Lamballe in 1834. The success obtained by this operator by his method, cystoplastie par glissement or autoplastie vi-sico-vaginale par locomotion, a procedure first proposed by Velpeau in 1834, attracted the attention of all Europe. From this time begins a rapid progress in the therapy of urinary fistula. One of the first to accept the method of the French surgeon, and to improve it, was Gustav Simon, then in Darmstadt, who had assisted Jobert in Paris at several of his operations. After him we may mention M. Sims and N. Bozeman as the two Americans who have carried the opemtive treatment of fistula to its highest perfection.