On surgical diseases of women / by I. Baker Brown.

  • Isaac Baker Brown
Date:
1866
Catalogue details

Licence: Public Domain Mark

Credit: On surgical diseases of women / by I. Baker Brown. Source: Wellcome Collection.

    354/468 (page 290)
    speaks of another instance, where a stone about as large as a goose's egg, after lying in the meatus urinarius seven or eight days, and causing retention of urine, was voided in a paroxysm of pain. (See Cooper's Surgical Dictionary, art. Lithotomy.) Dr. Molineux records a case (Philosophical Transactions) in which a woman voided a stone of which the long circumference was between seven and eight inches, the shortest circumference (in the thickest part) five inches and three quarters. I have myself extracted a stone through the dilated meatus three inches and a half in circumference; and in the case already quoted, in which Mr. Thomas extracted an ear-pick from the bladder, he says, The left forefinger was most easily introduced, and, I believe, had the case required it, both thumb and finger would have passed into the bladder without the smallest difficulty. It is clear, therefore, that there is no absolute or mechanical necessity for incising the canal in order to allow ordinary calculi to pass. Still objections have been brought against the practice of dilatation; namely,— 1. That it frequently takes a long time and gives great pain to dilate the urethra effectually. 2. That laceration is liable to occur. 3. That incontinence of urine has sometimes fol- lowed. To these objections it may be replied, that—1. The tediousness of the operation, and the pain it produces, are objections, the force of which has been dissipated by the in- troduction of anaesthetics into operative surgery ; and in such an operation chloroform has a double claim upon our notice; for it not only prevents all pain, but tediousness likewise. So long as the patient is conscious, the process of dilatation is rendered difficult and tedious by the contraction of the sphincter fibres of the meatus; but under chloroform these fibres are relaxed, and the dilatation can be accomplished easily and quickly. 2. The second objection-is disposed of in the same way. Laceration can only occur, in the walls of this loosely arranged structure, in consequence of the rigidity of the muscular fibre; relax this rigidity by chloroform, and the danger of laceration no longer exists. 3. Incontinence of urine does not occur after dilatation under chloroform. And I think this may be thus explained: when the dilatation has