A new lithotomy operation / by Hugh Owen Thomas.

  • Hugh Owen Thomas
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: A new lithotomy operation / by Hugh Owen Thomas. Source: Wellcome Collection.

    11/18 page 11
    My experience of secondary haemorrhage consists of only two cases of lithotomy, and one of perineal section. The mishap in the two lithotomy cases, I attribute to entering the perineum not so low down as I do now; a fault of my earlier operations. The first case was operated upon November 20th, 1868 ; the second, November 7th, 1873. The first case bled the fifth day after the operation, when the drainage-tube—which was small—not acting, the patient became feverish and delirious. He was placed to sit in warm water, which relieved the constitutional symp- toms, but was followed in a few hours by an alarming haemorrhage. Now there was done—what should have been done before—an exploration of the wound with an oiled finger; tube introduced, and wound plugged around it. This did not answer the purpose, so it was removed, and the wound dilated with a female urethra dilator, and the large clot which I found in the bladder was removed with the urethral forceps. The dilator was retained inside two days, when it was removed, and in its place was introduced a small bivalve rectum speculum, which was removed in three days, and the patient after this did very well. The patient's age was about twenty-five years. The stone was a round mulberry two inches in diameter. My second case in which haemorrhage occurred, the tube was removed November nth, four days after the operation. November 13th, slight bleeding occurred, and the tube re-introduced, and retained three days, which arrested the haemorrhage. Again, one day after removal of tube, there was free bleeding which was controlled by pressure of the finger on the left side of the wound. This was withdrawn after three hours, and a large tube introduced, and the patient remained free from haemorrhage until November 27. Then a large tube, with three quarter's of an inch bore, containing ice was introduced; nevertheless, November 30th, bleeding occurred again, and the bladder became full of clot. This was removed by suction. December 6th, bled again. Now a glass tube was carefully fixed obliquely in the wound, so as to press on the left side of the wound, This was retained until December 22nd, when a rubber catheter was passed into the bladder to drain, per urethram, and the case rapidly recovered after this date. The third case of haemorrhage occurred after perineal section to relieve stricture. Blood persistently oozed from the wound for three days, and the patient became so drained that he appeared much blanched, and I decided to put a tube in the wound, and firmly stitch the wound with deep sutures, and thus arrest what was only a general oozing, using a large curved strong needle for the purpose ;
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