Report of twenty-five cases of urinary calculus, in twenty-three of which the bi-lateral operation was performed / by Paul F. Eve.

  • Eve, Paul F.
Date:
[1852]
Catalogue details

Licence: Public Domain Mark

Credit: Report of twenty-five cases of urinary calculus, in twenty-three of which the bi-lateral operation was performed / by Paul F. Eve. Source: Wellcome Collection.

    3/18 (page 43)
    Case VI.—A negro woman, aged twenty-four, married and has borne one child, came from Alabama, and was cut in January, 1846. The calculous formation in this case was evidently the result of an injury to the bladder. Four years before her arrival here, she fell astride a projecting bar, and sus¬ tained, no doubt, a fracture of the pelvis. There was great contusion of the external organS*of generation; the patient was confined six months to bed, unable to walk; and for a year could not labour. Great difficulty was expe¬ rienced in micturition, little urine could be retained, and for four months the catamenia had failed. An inch and a half behind the orifice of the urethra, a small object was felt projecting into the vagina, and the sound instantly detected a foreign body in the bladder, apparently filling it. A vesico-vaginal fistula already existing, in operating, the urethra was laid open to it, and a piece of bone, coated with uric acid, was removed. This was the foreign body which had ulcerated through the bladder into the vagina; was of an irregular shape, and about three-fourths of an inch square. A large, soft, calculous mass felt in the bladder was now scooped out, and then its nucleus, another and larger piece of bone, was seized, but could only be extracted after a second incision made in the soft parts towards the clitoris, and by repeated efforts. Nor was the bladder even yet emptied of foreign matter, for during the treatment, a calculous mass, weighing forty-five grains, was passed through the wound. The duration of this operation was about an hour, and left the patient quite exhausted. Incontinence of urine, so much to be apprehended after lithotomy in the female, was certainly expected. This, however, she has not only escaped, but has been restored a useful servant to her owner. The composition of the calculus was uric acid ; the nuclei, when saw.ed in two, presented the cancellated structure of bone, and were reduced byre-agents to animal matter and phosphate of lime. Remarks.—In reference to the result of incontinence of urine after litho¬ tomy in women, we think a difference will be observed dependent upon the age of the patient. In children this deplorable event will, we think, be found pretty uniformly to follow the operation, while the adult female may escape. This is just what might be expected from the relative development of the organs interested in its performance. We have received the particulars of a case in which the urethra and vagina were freety incised in childhood; this patient lived to become a young lady, but was ever an object of disgust to herself and of pity to her friends; death happily relieved her condition, made worse by lithotomy. One of our pupils, Dr. Groce, of Alabama, has pub¬ lished the case of a married lady, in which he cut immediately upon the stone through the vagina and urethra, and after removing it, was to his great surprise, on being summoned to the same patient, eight days afterwards, called upon to re-open the wound for the purpose of extracting a second calculus; and yet she fully recovered, bore a child, and enjoyed unusual health. And in the case suggesting these remarks, the recovery has been equally good, notwith¬ standing the free incisions made into the soft parts under very unfavourable circumstances. Case YII.—Dr. II-, when about twenty years old, and living then in Henry County, Georgia, was relieved by lithotomy, in April, 1847. He had