On the comparative advantages of lithotomy and lithotrity : and on the circumstances under which one method should be preferred to the other : being the dissertation for which the Jacksonian Prize for 1838 was awarded / to Edwin Lee.

  • Lee, Edwin, -1870.
Date:
[1842]
Catalogue details

Licence: Public Domain Mark

Credit: On the comparative advantages of lithotomy and lithotrity : and on the circumstances under which one method should be preferred to the other : being the dissertation for which the Jacksonian Prize for 1838 was awarded / to Edwin Lee. 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.

    46/66 (page 12)
    of stone are also in general much less severe, frequently very ob- scure, and, where paralysis of t!ie bladder has preceded the forma- tion of the foreign body, are sometimes absent altogether, the ex- istence of the stone not being discovered till it has attained a large size, which usually occurs much more rapidly under these circum- stances, on account of the urine being retained longer and giving rise to deposition of the phosphates. Here the peculiarities in in- dividual cases will require to be attentively considered, in order to enable the surgeon to decide upon the most preferable mode of operating, or whether any operation be advisable ; as, when jiara- lysis of the bladder exists, the generally diminished vitality of the system or disease of other parts, might render a too active surgi- cal interference prejudicial. When an operation is determined upon, and there is a large stone or several stones, or an enlarged prostate, which would impede the removal of the fragments, litho- tomy would be preferable. In those cases, however, where the atony of the bladder is less complete, and the patient still possesses the power of voiding some urine at stated intervals, though he may not be able to empty the bladder, lithotrity would offer great pro- bability of success, the diminished irritability which so commonly attends impaired muscular contractility, being in favour of the ope- ration, which would be less painful and less likely to be followed by accidents; nor would the fluid injected be forced out, as often happens under other circumstances, and consequently the ])arietes of the bladder would be less likely to be injured by the instrument, 'i’lie repeated injection, especially of cold water, is serviceable in these cases by removing the accumulated mucus, and frequently tends to restore the tone of the bladder, the contractile power of which is also sometimes increased by the stimulus of the instru- mental manoeuvres. Small fragments and detritus may be remov- ed by the scoop or catheter forceps, constructed by W'eiss, or by injecting water into the bladder with some force, through a full- sized silver catheter with large eyes. In these cases also, lithotrity offers a means of getting rid of the foreign body, when lithotomy would be counterindicated by disease of the kidneys or other parts ; by disorder of the general health, &c. W hen lithotrity is performed under these circumstances, M. Civiale insists strongly upon the sittings not being long-continued, which is the more likely to happen, as, from the comparative absence of pain, the operation is generally well borne, and the surgeon is deprived of a monitor, which, if present, would warn him when to desist; and, according to the same high authority, the prejudicial effects ot the sittings having been too much prolonged, would not fail to be cvi- dence'd, not so much by local symptoms, as by the supervention of a state of low fever, constitutional irritation, impaired digestion, and general health, which would frequently terminate the patient s life.