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.
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![screwed down light])' on the object caught. The patient said he felt no- thing whatsoever (I had forgotten that his atonied bladder was almost in- sensitive), and as I moved the jaws of the lithotrite, the object caught moved freely, since the thin flabby walls of the bladder were more like a a bag of soft wet leather than anything else. Still the patient continued to assure me that he felt nothing, and I had not at that time any education in my touch to teach me what I had caught. I, therefore, screwed the male blade down lioping to crush the woven catheter at the point caught, and then, relaxing the male blade, to have a flexible hinge upon which the two ends of the catheter could bend backward during their passage through the neck of the bladder. So loose were the tissues in this case and so insensitive the bladder, that the patient made no complaint until I had withdrawn the lithotrite to such a distance as to put the tissues into a condition of tension at the point caught. Then came the first mild complaint, and now by free rotary movements of the lithotrite I learned that I had caught the bladder. I unscrewed the lithotrite and made all efforts to liberate the bruised fold of mucous membrane, but it had been cut and crushed to such an extent by the sharp male blade that I failed to disengage it and succeeded only in tearing away the piece which had been caught and bringing it out through the urethra. The piece contained some muscular fibres, but was, mainly, a strip of mucous membrane one inch long by one-third of an inch wide. No blood followed this violence; no chill, no increase in the cystitis, and on the next day but one, with a small scoop lithotrite I had no diffi- culty, without ether, in catching and extracting the foreign body. No harm came to the patient. He died five years later of apoplexy. Case B While trying to construct an instrument which would not clog, and working with great rapidity in one case of slow old-fashioned litho- trity without ether, I pinched up a small piece of mucous membrane along with the stone and bruised it considerably, bringing away a minute shred of mucous membrane and occasioning some hemorrhage. The intensity of the cystitis was aggravated in this case although there was no chill; but whether the cystitis was due to the injury done the bladder (which was very moderate), or to the broken mass of stone left in the viscus, is not evident. This patient was shortly afterward subjected to rapid lithotrity at my hands, and promptly and entirely relieved. Since adopting the operation of rapid lithotrity I have never once pinched a fold of mucous membrane in the bladder. I have frequently with various instruments caught a trabeculated fold of the bladder by making an effort to do so, but I have caught it lightly by design and for a purpose, always recognized it when caught and dropped it without pinch- ing- My experience in injury to the deep urethra during lithotrity is the following:— Case C A Reliquet lithotrite made by Collin and warranted not to clog was used by me upon a case of slow lithotrity without ether. Collin, contrary to the instructions of Reliquet, had made the male blade too short, so that it could not penetrate the female blade and clear itself. This I did not observe, but used the instrument to test it in the hospital. It clogged frightfully. I was unable to disengage the debris in the bladder and had to use some force in extracting the clogged jaws at that point ot](https://iiif.wellcomecollection.org/image/b22458207_0008.jp2/full/800%2C/0/default.jpg)
