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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    which I have practised in one or more of the foregoing cases with the lithotrite, and which I have also alluded to in using the forceps in lithotomy as a means of securing a grip of the stone, adverted to, by Sir B. Brodie. I shall quote his own words. If on the introduction of the lithotrite Avithin to the lower and back part of the bladder, and on the separation of its blades, the stone does not fall into the lithotrite, the forceps, without being moved from its situation, may be gently struck Avith the hand on one side, or on its anterior part, and the slight concussion thus communicated to the bladder, will probably be sufficient to dislodge the calculus and bring it within the grasp of the instrument. If it should be other- wise, the forceps being closed may be very gently and cautiously turned to one side or the other, so that the curved extremity of it may make an angle of 25° or even 30° with the vertical line of the body, then opened and passed in the direction of the rectum, in the manner already described.—(Trans. Med. Chir. Soc, Vol. XXXVIII., p. 174.) The chief advantages of this proceeding is to place the instrument in a position presumed to be advantageous, and to bring the stone to the instrument. On the perusal of the foregoing cases it will be perceived that I do not approve, after crushing the stone, of working away in extracting the fragments; if the urethra is free, and in that condition which would warrant lithotrity, the fragments must be left for expulsion by the contractile force of the bladder itself; it may be said, the bladder in its deranged state, so contracted, so irritated, cannot expel the detritus; if the bladder is in this state I would say cut the patient; if the bladder is in this condition that it has no power in expelling its contents, and so the broken up fragments, surely the most sceptical must admit, it is in no state to admit with impunity, without seriously resenting the irritability and violence created by the oft-repeated introduction of lithotrite, or catheter for the suction bottle, to mechanically extract those portions of stone recently broken up. When the bladder is inflamed even secreting pus, absolutely on the verge of ulcer- ation in some patches, how can it be credited that this practice can prove salutary ? No doubt, in some instances, cases seen early before all the serious consequences of stone in its advanced stage are set up; the calculus may be broken up into fine fragments, and extracted piecemeal, with good instruments and a steady hand, without much pain and with Httle or no harm to the patient; and yet his urethral membrane may be torn, as I have seen by this quick method and