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cannot be dispensed with, as you have at first no guide to the spot; but having discovered this line of demarcation, which is seldom, wanting in these cases, your attention is concentrated upon the small circle in which you feel. . Now if the matter is in the deep interstices of the muscles, or even at the bone, and that in a small quantity, you will most assuredly discover it, by managing the thumbs as I have directed. The gentle elevation is felt with the stationary thumb, while you press firmly with the other, having all still around.

If it is determined to evacuate the matter, it would be well, if there is cause to believe that the quantity is small, to mark the point with ink before your thumbs are removed; otherwise if you should remove your eyes and thumbs for a moment from the limb, and place the scalpel but a small distance from the spot where the elevation is designated, you might be led by the cavity, which would occasion great embarrassment and confusion. In such cases I always mark the centre of the spot in which the touch gives assurance of the presence of matter-I then proceed with coolness and determination, and as I before remarked, I have never been disappointed.

There is one circumstance which might prove a source of deception. On applying the thumbs over the belly of a single muscle, thinly covered with cellular substance, without considering its anatomi

a

cal structure, you might mistake the sensation arising from a pressure of it for the rising of a fluid. If

you fix them transversely to the fibres, the feeling so much resembles that of a fluid that, in some instances, there would be danger of deception. Attention to this hint will cause a distinction to be noticed. But if you place them longitudinally with the fibres of the muscles, and press perpendicularly, the sensation will not be experienced.

This subject of deep seated matter applies with almost equal importance to the whole class and variety of tumours. What tumour is there, presented to us for examination, which does not involve the question of its contents; and particularly, whether it contains a fluid or not? A correct decision of this question, in most cases, determines the character of the complaint. It constitutes the business of our profession to make that distinction, which is the only basis on which we can with confidence prescribe.

In a case of swollen scrotum, there may arise three questions—whether it be Hernia, Schirrus, or Hydrocele; for the external appearances may be very similar in all these complaints. There is no way of distinguishing these very different diseases except by the symptoms and touch. Suppose you decide that it is Hydrocele, when it is either Hernia or Schirrus, and pass a trocar into it—how unpleasant the mistake! I have more than once

been called to operate for Hernia, and upon examination discovered that the tumours contained pus. They were opened, and the patients did well.

One further observation will conclude these remarks. Within a few years three female patients have been sent to me for the extirpation of their breasts. On minute examination I found that the tumours contained a fluid. They were situated in the centre of the breast, and rather under the glands, which gave them a formidable appearance.

a On making an incision down to the tumours, they were found to be sacculated, and were healed in a few days by adhesive inflammation.

It would have been very unkind, through inattention to the true nature of the complaint, to have subjected these

young

ladies to painful operations; and what would have been more to be regretted, to have lost those useful and beautiful organs.

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VOL. IV.

ARTICLE VII.

A DISSERTATION

ON THE

UNCERTAINTY OF THE HEALING ART.

By GEORGE CHEYNE SHATTUCK, M. D.

Read before the Massachusetts Medical Society, at their Annual Meeting, June 4, 1828.

The Massachusetts Medical Society was organized, that individual feebleness might be sustained by associated strength ; that the retreat of self-love and private interest might be occupied by a laudable esprit du corps ; that Ishmael might feel the touch of a brother's love; that physicians, by the interchange of experience, might more successfully oppose the inroads of death.

The Fellows of this Society meet like neighbours, somewhat removed. Neighbours, a little removed, on coming together, usually fall into discourse on some topic within the compass of their common trials. The trials of the physician are numerous.

On the commencement of his career the lowering indignation on him of his neighbourhood as casting the

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VOL. IV.

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