Case of rapid lithotrity : with remarks on Bigelow's operation / by James F. West.

  • West, James F., 1833-1883.
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Case of rapid lithotrity : with remarks on Bigelow's operation / by James F. West. 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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    gets tired of holding the india-rubber bottle during a long operation. I have never seen the instrument figured in Dr. Reliquet’s pamphlet* on this subject in use, and which he calls the “ aspirateur Clover modifie par Nelaton et Collin,” but as it acts on the same principle as the well known irrigator enema apparatus, I think it would very likely be both handy and serviceable as an evacuator. The great question of difficulty in Bigelow’s operation is how long should the operation be prolonged : we can readily understand operations lasting from half an hour to an hour without inflicting any great risk on the patient, but can they, as Bigelow says, “ be successfully extended to three hours or more ? ” Anaesthesia produced first by laughing gas and subsequently by ether, as practised by Mr. Clover, which is probably the safest way of effecting it, can hardly be kept up so long without danger; and I cannot help thinking that if the operation should exceed in duration an hour, or an hour and a half, it is better for the patient that he should be removed to bed, and that a second or even third operation should be undertaken at intervals of two or three days. The frequency with which fragments obstruct the urethra after lithotrity, and the rigors and constitutional excitement to which such impactions give rise, warn us that it is necessary to be near the patient, or to have a skilled assistant at hand to remove, with forceps, any pieces that may have lodged in the anterior part of the urethra, or to push back into the bladder, with a large staff, any fragment that may have stuck in the prostatic portion of the urethra. That there is great risk to the patients in the passage of large fragments along the urethra there can be no * De la Lithotritie Rapide, Paris, 1882 (page 49).