5thly. "The removal of the cancerous womb, when the ulceration first makes its appearance. Might not the womb be taken out above the symphysis pubis, or through the outlet of the pelvis?" &c. 27.
6thly. "Extirpation of the puerperal uterus." He suggests the removal of the whole womb after the Cesarian section, in order that the smaller might take place of the larger and more formidable wound through the uterus—but says expressly, "No operation perhaps can be more unpromising, shall I say more unjustifiable, in the present state of our knowledge; but I thought it proper to mention it." &c. p. 28.
7thly. "Should the bladder give way into the peritoneum," he asks, "Why should we not lay open the abdomen, tie up the bladder, discharge the urine, and wash out the peritoneum thoroughly, by the injection of warm water?" p. 28.
8thly. - - - - -
9thly. Injection of astringents into the ovarian cyst or peritoneal sac, unjustifiable.
10thly. "In cases of strongly characterized introsusception," why not make an opening into the peritoneum; and "pass the small intestines, fold by fold, through the fingers." Dr. B. has repeatedly done this in the dog and rabbit, without producing death, or extensive and dangerous inflammation.
11thly. In the rabbit, he has tied an abdominal artery, and carried the end of the ligature with a broad needle out through the back, opposite to the place of the vessel. This ligature can come away, and is a better mode than to leave it hanging out at the abdomen, or entirely among the bowels, where it forms a sac of puriform matter, and to appearance lays the foundation of chronic disease. p. 30.
Dr. Blundell closes this paper by saying, that since the substance of it was read before the Medico-Chirurgical Society in 1823, Dr. Ritzius, a Swedish physician, had informed him in London, "that the complete removal of the cancerous womb had been, to his personal knowledge, performed on the Continent five times. All the patients recovered from the operation," &c. "The womb was removed through the outlet of the pelvis." p. 36.
Since we read Dr. Blundell's recommendations to the new operations, we have been astonished to notice in the Ed. Med. and Surg. Journal, July, 1825, that a German surgeon had actually treated a case of ileus in the manner recommended by Dr. B. It is from Hufeland's Journal of Feb. 1825. After it was ascertained that an immoveable introsusception existed—
"The patient was placed on a convenient table. We examined accurately the situation of the hardening, (which marked the diseased part), and determined on opening the abdomen at the outer edge of the right rectus muscle, about two inches above the navel. After dividing the integuments with a common scalpel, and making a small opening in the peritoneum, I introduced my finger, and with a blunt pointed scalpel divided the peritoneum, so as to make it correspond with the external opening, which was between two and three inches. I then besmeared my hand with oil, and carried it into the abdomen, in order to feel for the indurated part. Scarcely had I introduced my hand, than an attack of the pain came on, and a portion of the intestines was protruded through the wound, which was immediately replaced by my assistant. On continuing the examination, I discovered in a transverse portion of the ileum, a foreign substance, just where the hardened intestine was to be felt. I drew the intestine out, in order to examine it more minutely. The intestine was neither inflamed nor expanded, but it contained in its cavity a soft coherent and compact mass, which at its upper part was somewhat compressed, and thus felt harder than the rest. So far as I could follow this part of the intestine, this contained matter was to be felt: I also here immediately detected an intus-susception, but in spite of all my efforts I could not reach the commencement of it, so as to bring it out. Two modes of proceeding were open to me, in order to remove the intus-susception; either to make a transverse incision in the integuments, from the right to the left side, or to open the intestine itself. The last mode seemed to me the most adviseable, both because the patient was already very much exhausted, and because the operation would be sooner completed. The intestine was opened at the end of the discovered intus-susceptio, and immediately a part of the strictured intestine came into view. I introduced my finger into the opening in the intestine, which was made about two inches in length, and gradually pushed the intus-suscepted part back from the right to the left side, whilst I gently drew that part of the intestine which contained the intus-susceptio towards me. By this means I fortunately succeeded in unfolding the tangled intestine, which amounted to two feet in length. There was not the slightest trace of inflammation, nor any thing unnatural to be discovered in the part; there was merely a round worm, which was situated in the upper part of the intus-susceptio. The intestine was brought together by means of six spiral stitches, after the manner of the glover's suture, and the end of the silk was allowed to hang out of the external wound in the abdomen."