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.

    36/64 (page 32)
    found the patient quiet, free from any marked pain; he had passed more water at a time than he had done for weeks, and with less distress; some powder and small fragments of tripple phosphate were discharged; took beef-tea freely; pelvis kept elevated, and with great benefit; for the three following days, he greatly improved, the character of the water was altered very much for tlie better, the distress and urgency in making it very much diminished; so that on the 6th, assisted by Dr. Bevan, I again proceeded to crush the stone, having gone through the same arrangements in placing the patient as on the first occasion, bringing him under the in- fluence of chloroform, injecting the bladder with warm water, &c. I as cautiously as before introduced the lithotrite, and readily seized a considerable piece of the stone, which by gentle force pulverized, so on a second and a third piece; this breaking was effected with the fenestrated instrument; I then withdrew it and passed in a fine scoop lithotrite, and pulverized several pieces. No efforts were made by the patient to shrink from the manipulation which I carried on, so admirably did the chloroform act, and by such quiescence I was enabled to apply the greatest gentleness, at the same time to act with the utmost precision on the fragments. After the instrument was removed the water that passed was very lightly tinged with blood; position, opiates, stupes, warm stimu- lants, diluents, as before. When visited at 5 o'clock p.m., he was comparatively easy, and had passed a fair quantity of water, and nearly two tea-spoonfuls of the broken up stone in powder and small bits. At 7 o'clock I was called suddenly to him, as he could not pass any water, and having a great straining and desire to do so. I gently passed down a full-sized silver catheter, and was obstructed just at the membraneous portion of the urethra by a solid body. I felt this at once to be a portion of stone impacted, and too large to get on. I endeavoured by gentle pressure to push it back, but could not do so by the amount of force which I considered it safe to employ, so I passed down a full-sized catheter with an open end and rested it against the foreign body; I then applied a syringe to the end of the instrument, and sent down a gush of water with considerable force, this, after one or two eiforts, was effectual in liberating it and carrying it in its current back into the bladder. The force of the column of water Avas effective, because acting in two ways—by its presence it lifted away as it Avere the sides of the urethra from the irregular sharp edges of the stone, while the weight and force of the centre of the column drove the