Three lectures on the surgical treatment of stone in the bladder : delivered in the Royal College of Surgeons of England, June, 1886 : also the address on the etiology and distribution of stone in the bladder, delivered at the Annual Meeting of the British Medical Association at Norwich, August, 1874 / by William Cadge.

Cadge, William, 1822-1903.

Date:: [1886?]

Credit: Three lectures on the surgical treatment of stone in the bladder : delivered in the Royal College of Surgeons of England, June, 1886 : also the address on the etiology and distribution of stone in the bladder, delivered at the Annual Meeting of the British Medical Association at Norwich, August, 1874 / by William Cadge. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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the bladder, and Clover contrived the rubber aspirator and large- mouthed catheter, which differ but little from those which are now in constant use. It is with a feeling almost of chagiin and regret, that I recall the fact that, as regards the suprapubic operation and litholapaxy, with Garson's plain hints as to the one, and Clover's helpful appliance in the other, English lithotomists and lithotritists should have overlooked the true meaning of these hints, and have left it to Petersen and Bigelow to recognise their intrinsic principles, and to adopt and fully introduce them into practice. It is true that Brodie, more than forty years ago, removed fragments of stone by suction, but he only advised it for the final fragments in a paralysed bladder. It is also true that, with Clover's rubber bottle and catheter, some of us have tried to clear bladders that could not clear themselves; but none of us had realised or thought of the possibility of attacking and removing at one sitting an ordinary stone from a healthy bladder. Otis's discovery, if I may so describe it, of the full dilatability of the urethra without injury, paved the way for the introduction of litho- lapaxy. Bigelow saw clearly enough that, without a full-sized evacuating catheter, the removal of any but small stones could not be effected at one sitting, but that with it, and with lithotrites of adequate strength, the field covered by lithotrity would be greatly extended. This anticipation has been abundantly proved ; the principle of the proceeding is good and sound, and the practice is brilliant and suc- cessful. But, while admitting and maintaining this position, I am not unaware that there is fome drawback to this picture ; that it is held by many surgeons, and, amongst them, some of the most eminent, that the success of lithotrity is, in too many cases, temporary, and not permanent ; palliative, and not radical; that, while the imme- diate result is good and satisfactory, the future history of a patient relieved by lithotrity too often is full of trouble, caused by persistent bladder-disease and frequently recurring stone. I cannot deny that there is some ground for this adverse opinion; how much, I will en- deavour to show. In the meantime, let me say a few words as to the operation, and then as to its application to children, to adults, male and female, and to the aged. Litholapaxy.—I have followed the usual method of operating. The urinary organs and urine are first brought into as favourable a condi- tion as possible, by rest and appropriate treatment. I invariably begin an operation with a fenestrated lithotrite of adequate size. The stones most frequently met with in the eastern counties are gene- rally composed of pure uric acid, and are of intense hardness ; so hard are they, that it has sometimes required my utmost strength of wrist, and the help of a towel folded round the handle of the instrument, to accomplish the first break of the stone. Dr. Freyer, in India, where very large stones are frequently crushed, has expe- rienced this difficulty, and has suggested the addition to the handle of the lithotrite of a cross-bar, which would give great power, would save one's hand, and could be removed when not required for large and very hard stones. As the fragments diminish in size, the un- fenestrated instrument comes to be the best; it holds, crushes, and pulverises the fragments better, and makes quicker work. It is de- sirable that all lithotrites should have the female blade made rough, so as to prevent slipping of the smooth round or oval stones when caught. These stones are apt to slide out of the instrument and escape when the male blade is pressed down on them, but this rough surface enables the blades to grip at once. Great care should be taken to raise the stone towards the centre of the bladder before u.sing the screw, so as to avoid contact with, and injury to, the mucous membrane. The evacuating catheters have varied but little from those first introduced by Bigelow. I have always used the curved, because it has seemed to me that the straight tube when

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