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.

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    free the impaction by making the proper movements in the bladder and by opening and shutting the blades. He, therefore, was obliged to exert as much force to extract the lithotrite as he would have done upon the forceps in a case of instrumental delivery of a child at term. The derangement in the screw, to which Dr. Weir refers, seems to have been occasioned by some efforts made to clear the blades. The jaws appear to have caught in some manner, so that some mechanical defect in the instrument was at fault, and not the principle of construction, at least so I understand it. As a result of this laceration of the urethra, produced by the violent withdrawal of the lithotrite not screwed home, Dr. Wynkoop states that abscess ensued, and, on this account, at a later date, lithotomy through the perineum was performed to evacuate the remains of stone left after the operation of litholapaxy. Since his lithotomy the patient is reported to have done well. Both of these cases confirm my proposition that injury to the fundus of the bladder, if the viscus can afterward be left empty, is of less import- ance than injury to the urethra. Hence the value of using small instru- ments, which cannot be made to impact by any possibility. Case XI., Dr. Wynkoop’s first case of litholapaxy, showed a number of abrasions and minute lacerations of the bladder at the autopsy. The patient’s general condition was bad, and this local violence had been suffi- cient to light up a peritonitis. Death followed twenty-nine hours after the operation. It is rather singular to note that these lacerations were what Professor Bigelow1 supposed would follow the use of an instrument, made according to the principle upon which I proposed to construct a fenestrated lithotrite” while in fact these lesions were occasioned during the use of his own in- strument. . Thls case only §oes 10 demonstrate what is indeed self-evident, that violence done to the bladder in a weakly subject may be followed by a fatal Is Litholapaxy a New Operation?—It was recognized long ago that the bladder would tolerate considerable injury without showing signs of dis- tress and the cystitis, after the short sittings of old-fashioned lithotrity was known to be due not so much to the injury inflicted at the moment of toTZ u t0 the cumulatiye effect of the repeated acts of violence done tL Operation!' 7 angUlar flBSmentS °f St0ne eonstantly present after Th.s fact was announced in so many words by Ileurteloup long a<m, and tauht0bvrTrSe0nS w-reC°gniZed ifc- Xt was M]y appreciated and (Thompson) had .commended as“a ^ ^ coming on Am. Journ. of Med. Sci., Jan. 1878. 1 Medical Record, June 8, 1878.