Stone in the bladder : lithotomy in the infant and the child ; crushing the stone in the adult and old, with the application of lithotomy to each, in certain cases, practically considered / by Richard G. Butcher.

  • Butcher, Richard G. H., 1819-1891.
Date:
1870
Catalogue details

Licence: Public Domain Mark

Credit: Stone in the bladder : lithotomy in the infant and the child ; crushing the stone in the adult and old, with the application of lithotomy to each, in certain cases, practically considered / by Richard G. Butcher. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    9th.—This day the water has ceased to come by the wound, which is healed up in all its deep parts, and nearly on the surface. The child has full power to retain the water, to restrain it in its flow, or to pass it with much force, and without the slightest degree of pain of any kind. 18th.—Wound healed, and child perfectly restored to health; no more pain. All the functions of the parts risked in the opera- tion perfectly distinct. Child dismissed cured in a few days after. I have laid particular stress upon the various steps of the opera- tion, as I advocate its performance, yet there are some points which I wish to repeat and dwell upon. The sounding of the patient in the first instance requires a few words. It should be ascertained whether the child had passed water recently; if not, all is well; but if so, the child should be placed recumbent, brought under the influence of chloroform, and then two to four ounces (according to age) of tepid water injected. The little sound should be then warmed, oiled, and gently, lightly passed into the bladder. To facilitate this result, the instrument should not fill the urethra, but glide easily along it; but other advantages flow from the instrument not being retained tightly in its route; its point can be elevated, depressed, moved to either side—in short, made to explore the bladder with freedom, and with a certainty that never can be obtained if the urethral grip be close, biting, and constricted. The instrument most effective in detecting the stone is one somewhat short in the sweep, and with rather a short curve; so constructed, it can readily be moved in all directions with accuracy and precision. When the presumptive symptoms of stone are present, and strongly marked, the surgeon should be tenacious of his opinion, and not lightly put aside the case because he has failed on one or two occasions in finding the stone. No; the child should be placed in bed, all irritation subdued by tepid baths and suitable medicine; and after a few days the examination may again be made, both in the recumbent and upright position, the bladder being, of course, in a state of repletion. If the stone be not detected while the patient is lying down, then a hollow silver instrument should be passed, and the position changed to that of standing up; the urine should then be permitted to flow slowly off, and very probably the calculus will strike the instrument, and give satisfactory evidence of its presence. I have laid stress upon passing the staff before the patient is tied up, and for these reasons:—In the first place, it is