Proceedings of the Philadelphia County Medical Society - Vol.8 (Session of 1887).

  • Philadelphia County Medical Society
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Proceedings of the Philadelphia County Medical Society - Vol.8 (Session of 1887). Source: Wellcome Collection.

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

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    SUPRAPUBIC LITHOTOMY, FOLLOWED BY DEATH FROM PERFORATING ULCER OF THE STOMACH. By JOHN B. ROBERTS, M.D. [Bead by H. A. Wilson, M.D., January 12, 1887.] The following case of removal of stone from the urinary bladder by the suprapubic or high operation, is reported as proving the position which I have so long insisted upon, that this operation is easily accom- plished, and is free from many of the dangers of the lateral perineal operation. C. H., aged sixty-tliree, applied to me for relief from frequent urination, and other bladder symptoms, and was sent to the wards of the Pennsylvania Hospital. Upon the introduction of the lithotomy sound, it was easy to dis- cover the presence of a stone. When the catheter was used, the stone was struck before any urine was drawn from the bladder, apparently proving that the calculus lay close behind the prostate gland. The patient was a very fat man, with poor circulation, and evidently a bad subject for etherization or operation. The urethra was large and easily distended. It therefore seemed to me proper to attempt the removal of the stone by the rapid crushing method. With this object in view, I had him frequently dilated with large bougies, in order that the urethra and bladder might become tolerant to the contact of instruments. Subsequent to this preparatory treatment, I made an attempt to crush the stone with a lithotrite, expecting to evacuate the fragments by the ordinary method of Bigelow. Repeated efforts proved the impossibility of seizing the stone, either because it was too large to fall into the grasp of the blades of the instrument, or because it was encysted behind the prostate gland. Even with a finger in the rectum, and with the jaws of the lithotrite turned downward, seizing the stone was impossible. As the man’s perineum was deep, and as I believed that the perineal opera- tion was inferior to the suprapubic one, because of the liability of hemorrhage, of injuring the seminal ejaculatory apparatus, and also because ot the sup- posed size of the stone, and its possibly encysted character, I determined to perform the suprapubic operation. After etherization, a rubber bag, to which was attached a long tube, was placed in his rectum, and filled with about twelve ounces of warm water. The bladder was afterward filled with six or eight ounces ot a weak solution