On litholapaxy / by Robert F. Weir.

  • Weir, Robert F. (Robert Fulton), 1838-1927.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: On litholapaxy / by Robert F. Weir. 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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    grains of fragments having been extracted through a No. 29 tube, in three applications of the aspirator, was stopped, as the patient’s breathing became unsatisfactory under the ether used. He passed a quiet night; no chill; and as no urine had passed by the morning, a soft catheter was introduced, and §iij of bloody urine withdrawn. The patient passed clotted blood. Avith the urine during the day, and he suffered considerably from nausea and flatulence. Temp, 103f° in the evening. Nov. 11, temp. 102^°; urinated without pain eyery half-hour: stomach still irritable. Nov. 12 and 13, was doing well; temp. 101°. Nov. 14, temp. 100f°, pulse 98. During day became drowsy, and passed less urine than usual, and with more effort. . In the afternoon had a severe pain in left renal region, followed by jactitation and slight coma. These symptoms of uraemia became more marked, and the patient died Nov. 15, 7.30 A. M. The autopsy showed distinct pelvic peritonitis advancing upwards and into the abdomen. The bladder, which was hypertrophied, contained several ounces of muddy and very bad smelling urine, and showed evidence of intense cystitis. The mucous membrane of the has fond, over a space as large as a ten-cent ])iece, was dark-colored, and shreddy, and showed a loss of substance (xtending through the mucous and muscular coats, but not further. Whether this was due to an ulceration or a laceration could not be determined; it was, however, thought to be the former, as the exposed fibres were coated with a decided layer of phosphates. In the median line, and just posterior to the orifices of the ureters, was found a fragment of a calculus about half the size of a bougie a boule. No. 30. It Avas imbedded in a mass of apparently necrotic mucous membrane. The kidneys were very soft and flabby, probably from decomposition, as the post-mortem changes generally had rapidly progressed. Microscopically, hoAvever, there were recognized shrunken glomeruli, with thickened Bowman’s capsules. Ca.se XI. —Dr. G. H. Wynkoop ; operation, Aug. 20, 1879; Jno. M. G., aged 55. Bigelow’s lithotrite (33 Fr.) used. Duration of operation eighty minutes. Litliotrite used tln-ee times, and aspirator three times. Largest seizure Avas half an inch, and the amount extracted about 5iss (estimated, as some Avas accidentally lost). The composition of the calculus Avas phosphatic. Reaction after the operation was good; the urine passed freely. The day after the operation the patient presented evidences of peritonitis, and died in collapse, Avith slight convulsive action, at 9 o’clock that evening, some twenty-nine hours after the operation. Autopsy revealed the bladder free from calculous matter, save that in one of tAvo small hernial pouches formed on the left side was found a small stone the size of a pea. On the posterior wall, and to the left side, was seen a linear laceration about three-quarteis of an inch in length, and involving the mucous membrane only. A little nearer the median line was an abrasion the size of a two-cent piece. On the floor Avei’e seen several minute lacerations, and spots of ecchymoses. The walls of the bladder, subperitoneal tissue, and the peritoneum, over the sites of the lacerations of the mucous membrane, shoAved evidences of inflammation; and in the peritoneal cavity were §vj sero-sanguineous fluid. The kidneys were both larger than natural, deeply congested, and so friable as to tear readily in the fingers. Case XII.—Dr. G. H. Wynkoop; operation, Oct. 17, 1879; William W., set. 34. Bigelow’s lithotrite, Weiss’s manufacture, used, size 33 Fr. The stone Avas a large one, the greatest grasp being If inches, and the time occupied in the operation Avas three and one-quarter hours. It Avas then de('ined advisalfle to postpone further attempts to rid the patient of the remaining calculous material, both on account of his bearing the ether badly, shoAvn by lividity and irregular breathing, and also by the difficulty met with in enteiing the bladder, by reason of a false passage formed by the end of the tube catching in an abrasion, Avhich had resulted, in its turn, from the instrument becoming impacted. This impaction, however, on examination after Avithdrawal from the bladder, was ascertained to be due to a fault of construction in the screw, which was of a too soft steel, for on turning back the catch or lock the jaws readily separated or went “home,”