Rapid lithotrity with evacuation / by E.L. Keyes.

  • Edward Lawrence Keyes
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: Rapid lithotrity with evacuation / by E.L. Keyes. 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.

    19/30 (page 17)
    Rest in bed two or three days before the operation I think is always desirable, and when the bladder is much irritated or inflamed, whether it be atonied and undergoing a course of washing or not, the free use of Bathesda or Poland water, or of some bland diuretic for a few days before the operation is of unquestionable advantage. If the urine be reasonably bright and clear, but over-acid and concen- trated, a little citrate of potash for a few days before the operation corrects it. Milk diet is useful. I am in the habit of ordering ten grains of qui- nia to be given two hours before the operation, and ten minims of Ma- gendie s solution of morphia subcutaneously just before giving the ether. The Operation—The details of operative procedure, as at present prac- tised by Dr. Van Buren and myself, are the following: If the bed is a high one, and the mattress solid, I prefer to leave the patient flat on his back, on the right-hand side of his bed, with something under him to keep the sheet dry. If the bed is not suitable a table should be used. Two assistants only are necessary—one for the ether, one for the washing bottle; and one assistant can sometimes do all the work. I have operated promptly and successfully (without ether) in my office without any assistant, and several times with ether, having only one assist- ant. It the patient takes ether badly, two more assistants may be desir- able to hold the legs apart. . 1 first test the calibre of the urethra with a steel sound to find what size of washing tube should be used, incising the meatus if it be small. If the urine has been reasonably clear and acid, the lithotrite is intro- duced at once, regardless of the quantity of fluid in the bladder, unless the stone be exceptionally large, when a little water may be thrown in as a first step. It the urine has been ammoniacal and putrid, it is first entirely drawn off and the bladder repeatedly washed with a saturated solution of borax an hot water, about a full drachm to the ounce,1 in the washing bottle until ie wash comes away sweet. I formerly used a one per cent, solution of carbolic acid, but I prefer the concentrated solution of borax, which is a better disinfectant and anti-zymotic at that strength, and quite soothing to the bladder instead of irritating, as is an efficient strength of carbolic acid. n the fatal case I used carbolic acid, but was unable to get the wash swee . Indeed after the end of the hour of operating, the Met wash tad a sl.ghtlj putrid smell, due doubtless to the admixture of a few drops of urine from the diseased kidneys. . 1 f ndt h most satisfactory to crush rapidly from six to ten times accord info the26 ^ ^ ^ t0 Wash until the ^bris ceases to fall eceivei, and immediately re-introduce the lithotrite while the assistant empties the receiver, and refills the bottle. Generally befole the 2 ' At 1100 F> a 8aturatcd solution of borax ]a 1 i„ 8 = 3iss in gj.