The removal of stone in the bladder / by Wm. S. Forbes.

  • Forbes, William Smith, 1831-1905.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: The removal of stone in the bladder / by Wm. S. Forbes. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    [Reprinted from The Medical News, June 23, 1894.] THE REMOVAL OF STONE IN THE BLADDER.1 By WM. S. FORBES, M.D., PROFESSOR OF ANATOMY IN JEFFERSON MEDICAL COLLEGE, AND CLINICAL SURGEON TO JEPFERSON MEDICAL COLLEGE HOSPITAL. It is my purpose to demonstrate: 1. T4ie measured crushing resistance of vesical calculi. 2. The measured strength of the lithotrite. 3. The lithotrite from a mechanical point of view. 4. A new lithotrite. Given the problem—a stone in the bladder, a limited viaduct to reach it : remove the stone with- out injuring the parts. There are two unknown factors in this problem: First, the crushing resist- ance of the stone, and second, the strength of the lithotrite used in reducing the stone so that it may be removed with facility. Knowing the crushing resistance of the strongest vesical calculus in our possession, we are in a position to proceed to so construct a lithotrite that we can successfully crush and safely remove such a stone were we to meet with it in the human bladder. So far as I know, the exact crushing resistance of a vesical calculus has never been stated by any writer. Such vague statements as “very hard,” “very tough,” “very large,” etc., have been used in describing stones, but the measured crush- ing resistance of any stone taken from the human bladder has always been overlooked. The same may be said of the lithotrite. “Very strong,” “very powerful,” etc., have been the vague terms used in describing it; but its measured strength computed by any unit has never been stated. In order to inform myself exactly on these points I addressed a letter to the Librarian of the Surgeon- General’s Office, Washington, asking for any infor- mation whatever the Library contained in regard to them, and his reply was that the Library con- tained nothing relating to the matter. It is manifest, therefore, that I have entered an entirely new field of investigation. Now, with a perfect disposition to respect the written law of this body to study economy of time, I shall strive to aim at all practicable condensation and brevity. A very liberal expenditure, however, is at times de- manded by the wisest economy; and if it shall be 1 Read before the American Surgical Association, June 1st, 1894, during the Triennial Congress of American Physicians and Surgeons. found—as I fear it may, from the almost elementary manner in which, to meet all exigencies, the ques- tions that arise must be discussed—that my own outlay offends against the letter of the law, I hope it also will be found that it is in harmony with its spirit. In order to attain the necessary knowledge for the solution of the problem in question, it is neces- sary first to measure the crushing resistance of a large number of stones taken from the human bladder, a very large number of every size, embrac- ing the hardest, toughest, and largest specimens, for it must be borne in mind that it is especially these that we seek to investigate, rather than those that are small and readily broken by very moderate pressure. So far I have been able to collect from all sources only 184 human vesical calculi for this investigation. The table herewith annexed, in which the results are given, is so arranged that any number can be added. I propose to continue these investigations, and from time to time I shall add and publish the results observed. I shall begin my task impressed with that fine saying of Coleridge : “ The conditions of science should be weighed in the scales of a jew- eller, and not like the commodities of the market on the weigh-bridge of common prejudice and vulgar error.” We find that the 184 vesical calculi tabulated are divided as follows: Oxalate of lime 55 Phosphate of lime ....... 64 Uric acid ........ 27 Oxalate and phosphate mixed .... 15 Uric acid and phosphate mixed .... 8 Uric acid and oxalate mixed .... 7 Oxalate, phosphate, and uric acid mixed . . 4 Combustible, requiring further examination . . 2 Carbonate of lime and oxalate . . . . 1 Cystin 1 184 Had time permitted, the grouping of the calculi in the table below would have been made on the basis of their chemical constitution, as indicated in the foregoing summary. At some future time this grouping will be arranged and all additions to it will be made upon this basis.