The median operation of lithotomy / by Kelburne King.
- King, Kelburne, 1823-1886.
- Date:
- 1856
Licence: Public Domain Mark
Credit: The median operation of lithotomy / by Kelburne King. 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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![of urinary infiltration, and from it the mesial operation is perfectly free. Purulent deposit and peritonitis are rather accidents which may attend all operations, and depend more on atmospheric and externa] causes than on any particular mode of operating; we may, therefore, dismiss them from our consideration, and turn to the remaining source of danger, inflammation of the neck of the bladder. This is, I believe the most frequent cause of death after lithotomy, and in the absence of statistics, we have to consider whether it is more likely to occur when the prostate is partly divided and partly lacerated, or when it is simply dilated. A stone of even from 1 inch to l-i inch in its smallest diameter cannot be removed in the forceps without more or less dilatation, i.e., laceration of the prostate. ^Ir Syme, in the clinical lecture alluded to, states that the prostate gland “ tears readily,” after the sensitive texture at its base has been divided, and indeed experiment on the dead body will convince any one that, after the prostate has been cut into, it does not dilate on the application of pressure, but tears ; and this torn structure is in contact with urine, which, getting into the fissures, excites in- flammation of a more or less acute character, and, I believe, pro- duces more fatal results in lithotomy than all the other sources of danger put together—except, perhaps, purulent deposits in crowded hospitals and unhealthy localities. But the condition of things is entirely altered if the prostate be not incised at all. It is then capable of very considerable dilatation, if that process be conducted with patience and gentleness. In the old Marian operation, the prostate was actually torn asunder by instruments, and there is no wonder that death often resulted from the laceration of the gland, the passage of urine into its substance, and consequent inflammation. The wonder is, that the mortality did not range higher.1 Mr Allarton’s proposal is of a very different nature. He recom- mends that the finger should he introduced, in the first place, and dilatation effected bv careful pressure—that long-bladed forceps should next be passed into the bladder, and, the stone having been seized, should be carefully and steadily withdrawn—the length of the blades causing the instrument, with the stone in its grasp, to act as a wedge, and thus assist in the process of dilatation. Even should the structure of the prostate tear under this gradual pressure, it is of little moment, so long as the mucous membrane remains entire, the urine being thus prevented from having access to the lacerated portions, which access, and not the mere fact of laceration of the prostate, constitutes, in my opinion, the grand danger in lithotomy. Such is a rapid glance at the usual sources of danger after this operation, and it seems to me that the median operation is less liable to them than the lateral. Indeed, I think the question narrows 1 See M. Coulson, Lancet 185.3, vol. i., p. 74.](https://iiif.wellcomecollection.org/image/b22336710_0006.jp2/full/800%2C/0/default.jpg)
