A system of practical surgery / [Sir William Fergusson].

  • William Fergusson
Date:
1842
Catalogue details

Licence: Public Domain Mark

Credit: A system of practical surgery / [Sir William Fergusson]. Source: Wellcome Collection.

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    be borne with difficulty ; and if the muscular fibres are excited to such violent contraction as to occasion the evacuation of the fluid contents along the side of the instrument, or to excite an irresistible desire to micturate, then assuredly the circumstances are peculiarly unfavour- able to the proceeding. A stricture may be cured ; the natural calibre of the urethra may be increased by dilatation ; even in certain cases the objectionable state of the prostate may be in some mea- sure overcome by means of large catheters, scoops, and proper position whilst voiding urine ; but the irritability—excitability, I may call it— and tendency to inflammation, which are almost certain accompani- ments, cannot so readily be coped with. It is very certain that in some instances the organs become more and more callous after the application of instruments ; but it is equally certain that the con- ditions above referred to often rather increase than otherwise, after the first, second, or third sitting; and, in addition, that in certain cases, where the conditions have not been by any means conspicuous before the operation, they have become so developed as to retard the whole proceedings, making each succeeding attempt more painful than the preceding one, so that the cure (if cure it can be called) is ultimately completed amidst the most miserable sufferings—miserable to the patient, and disheartening to the surgeon,—when, from time to time, as a favourable opportunity presents, he has again to resume his attacks upon the original cause of the suffering—the stone—which may at this time be already comminuted into a variety of fragments. While I do not hesitate to assert that the above picture is by no means overdrawn, it must be admitted that the effects are very dif- ferent in the majority of cases in which lithotrity is properly appli- cable : and here be it remarked, there is a vast difference between such examples and those in which, unfortunately, it is attempted ; for when the circumstances are favourable, viz., when there is a large and callous urethra, a capacious and apathetic bladder (if I may so call it), with good muscular power, a healthy prostate, and a small or moderately-sized stone, the operation may be done once, twice, or as often as may be required, with as little annoyance to the patient as if he were only undergoing the treatment for stricture. Supposing lithotrity to be the mode of treatment, the method of crushing the stone into fragments is that which is now in general use, having almost entirely superseded the percussing force of Heurtcloup, and also the process of drilling by means of a straight instrument, which was at one time so extensively used by Civiale, but which, we learn from Mr. Edwin Lee, in his Dissertation on the subject, for which he was awarded the Jacksonian Prize for 1838, is at present scarcely ever employed by that distinguished lithotritist. The curved instrument originally devised by Mr. Weiss, in 1823, formed the type of those which have since been so much improved—it may be said perfected—by himself and M. Charriere. The lithotrite of the pre- sent day consists of a male and female blade, which, while they are so adapted to each other as to resemble a common short-curved sound,
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