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.

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    existence of stone; the blailder, in fact, contained no stone, but two large fungous masses, and several smaller ones. Another case is related by Mr Key in the Guy’s Hospital Reports, where li- thotrity was recommended, though it was subsequeutly ascertained that the bladder contained no stone. Thus we see that reliance cannot always be placed on an e.xa- mination of the bladder by the sound; even as far as concerns the ])resence or absence of calculi ; still less on their size, densi- ty, and composition ; though in many cases a tolerably near guess may be fonned on these points, by the extent of surface traversed by the sound, laterally and from before backwards ; by the weight of the stone when pushed on one side, by the kind of noise caused by striking it; as, if it be hard,—as of the oxalate of lime or lithie acid varieties,—a clear distinct sound will generally be emitted ; while, should it be of the phosphatic variety, the sound on per- cussion will, in most instances, be dull, as when a piece of chalk is struck with a metallic rod. Were more care taken to sound patients in difterent positions than is generally done, especially with the pelvis raised higher than the abdomen and with the blad- der in alternate states of fulness and emptiness, information of a more definite character might frequently be obtained even with a common sound ; and still better by the employment of lithotritic instruments, which have in several instances served to detect stones and fragments in the bladder after the sound had failed in ascer- taining llieir presence. For this purpose the curved instruments ap- pear tome better adapted than the straight three-branched lithotrite ofCiviale, inasmuch as the shortness of their curve admits of their being turned completely round in the bladder, and enables the surgeon to feel with the beak of the instrument foreign bodies lodged behind and beneath the ])rostatc gland, which a common sound or a straight instrument like Civiale’s would pass over, and leave undetected, especially in cases where there exists enlarge- ment of this substance. In obscure cases a lithotritic instrument has, moreover, the advantage of ascertaining more accurately the size of the stone, as when this is seized the surgeon may always see by referring to the graduated scale near the handle, the ex- act diameter of the part cmbracc<l between the branches. With this instrument, also, the surgeon is better able to ascertain whe- ther the bladder contain more than one stone, as, by moving the in- strument in various directions with the stone in its grasp, it would in all probability strike against other stones if any existed; ami if the stone were not hard, its composition might be known, or at {ill events, that of its outer layer, from the nature of the detritus adhering to the instrument after it is withdrawn. Explorations of the bladder, however, with lithotritic instruments are generally more painful than ordinary sounding, and arc not always harmless;