Clinical lectures on diseases of the urinary organs : delivered at University College Hospital / by Sir Henry Thompson.

  • Thompson, Henry, Sir, 1820-1904.
Date:
1882
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Licence: Public Domain Mark

Credit: Clinical lectures on diseases of the urinary organs : delivered at University College Hospital / by Sir Henry Thompson. Source: Wellcome Collection.

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    calculus by alkaline agents taken in- ternally. I will go further, and express my belief that, given abundance of time and careful supervision, it may be possible. Nay, I will do more; the first case of such a kind that comes into the hospital, the patient consenting, I shall be pleased to submit to the process, and to give it a fair trial. But this I say with certainty, that there is no evidence what- ever that one case in a hundred of those who have swallowed solvents for the stone has been cured of it, during all past ex- perience down to this day. No man who deliberately takes solvents for even a small calculus the characters of which have not been carefully determined, can reckon on any better chance than this— viz., that it is a hundred to one against their success, and that it is probable that his stone may grow bigger meantime. And if the stone be large, the solution is im- possible. What is the value of the treatment in question ? It is impossible to say more than that it may be valuable, not for stone in the bladder, but for that earlier stage of the same malady—stone in the kidney. That is the period of its history in which to attack the stone by solvents. When small uric-acid calculi are passing periodically or occasionally, much may be done: first, and I believe mainly, by preventive treatment, on principles I have already explained to you in a lecture devoted entirely to that subject; and that being insufficient alone, secondly, by alkaline treatment. With these two to- gether, there ought in time rarely to be much trouble with stone in the bladder. I confidently anticipate a future in which any severe operation for stone will be rare. Uric-acid stones only, as you know, are amenable to the process by solution, but, happily, they form the very large majority of renal calculi. I must say a few Avords about agents to be used locally in the bladder for the solution of phosphatic stones, which are not dissolved, but rather increased by the internal remedies already described. You know that there are many patients, chiefly those who are unable to empty the bladder except by catheter, who are very prone to form calculous matter of the mixed phosphates, and this at a rapid rate. For these persons acid solutions injected into the bladder may be valuable. The patient may be taught to administer them himself; numbers have been taught in my wards. Once or twice a day, after withdrawing all the urine by ca- theter, he applies to the end of it a four- ounce bottle, with stop-cock, containing a solution of acetate of lead, about one- third or one-half a grain to the ounce of distilled water, or of one, two, or three minims of dilute hydrochloric acid to the ounce. He throws in half the contents, and allows it to issue, carrying out with it some small debris perhaps. He next injects the second half, and allows it to remain there. This does much to prevent the formation of phosphatic calculus, or, at all events, of the aggregation of its- elements in the bladder. I have no- intention to describe now at length the methods of mechanically dissolving or washing out these matters, when the above simple means are unsuccessful [more- complete details in reference to this sub- ject will be found in Lecture XIV.^ p. 93]. I must not omit to name the agency of electricity which has also been locally employed, both for uric-acid and for phos- phatic stones. Prevost and Dumas (1823) attempted direct solution of a stone in the bladder by the galvanic current, a plan which was more fully developed here by Dr. Bence Jones (1852). The amount of instrumental manipulation, however,, necessary to bring the wires into contact with the stone and to maintain them there during the period necessary for its solution is considerably greater than that required to crush the stone by the modern method of lithotrity, and must therefore be regarded at present as in- applicable. And now comes the inevitable final conclusion—inevitable because true. It has been shown that there is no chance for the dissolution of any but a small stone, and this provided only that it exists in the most favourable circum- stances: and lastly, that in order to accomplish the task a considerable period of time must be devoted to the process. For such a stone, Gentlemen, but one brief sitting by lithotrity is necessary. And no operation in the whole range of surgery is more certainly safe, rapid, and successful. I repeat the statement, that such a case I have never lost in the whole course of my experience. Nevertheless, let the patient's voice be heard in de- termining the course to be pursued. He