Case of removal of stone from the bladder by the new operation of lithectasy or cystectasy, with remarks / by Thomas Elliot.

  • Elliot Thomas, 1817-1859.
Date:
[1843?]
Catalogue details

Licence: Public Domain Mark

Credit: Case of removal of stone from the bladder by the new operation of lithectasy or cystectasy, with remarks / by Thomas Elliot. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    or from morbid irritability,—the operation could be at once com- pleted by converting it into lithotomy. It will be unnecessary to repeat the reasons before given, for the preference afforded to this phn <^Per0f^1|‘t]ie dilator gent to me by Mr Weiss might be improved by making it cylindrical, and not tapering towauls each end. There would thus be no risk of its slipping from its posi- tion. The signs of its being properly placed are the feeling of distention and immobility. When it slips into the bladder, (as happened in this case, on removing the patient from the table,) the instrument can be pushed inwards towards the bladder, cannot be withdrawn, the tube is very moveable in all directions, and the patient experiences tenesmus vesicce, without any feeling of distention. It would be better if the dilating pait of the instrument was of sufficient length to appear in sight, as the ope- rator would be not only certain of its position, but able also to judge of the degree of tension when injecting the fluid,—a much safer criterion than trusting to the feelings of the patient, who might possibly submit without complaint to a pressure that would prove injurious. The instrument would be also improved by at- taching a small stop-cock to the urine tube, and another to the tube that communicates with the dilator, as that which screws into the syringe is apt to slip when left in the tube. If the piston of the syringe was graduated, and the dilator perfectly water-tight, the surgeon would be able to judge exactly of the degree of distention of the prostate by the quantity of the fluid injected ; and this would at once enable him to remove the instrument as soon as the dilatation was complete. 6. The length of time requisite for dilating will, of course, vary according to the resistance of the prostate and degree of force used ; but I would strongly urge its being done at intervals, for, say quarter of an hour at a time, as less likely to cause irritation than if continued for a period of 30 or 40 hours, as has been mentioned. When the dilator was withdrawn in this case, two fingers could be introduced with the greatest ease along with the scoop. The instrument, when fully distended, measures 4^ inches in circumference, and is about the size of a hen’s egg; and a stone of the same dimensions might have been easily extracted. Though twenty-five hours elapsed before the removal of the stone, it could have been as easily effected, and the dilation must have been as complete, at the end of the third hour, since no ad- ditional fluid was thrown in after that time. This period was allowed to elapse, as I certainly did not expect to meet with so little resistance, and be able to complete the operation in so short a time. The alterations in the length of the dilating part of the instrument which I suggested above, would have at once