EXTRACTION OF CALCULI FROM THE BLADDER, BY WEISS'S URETHRA DILATOR.

770

place in the night, much difficulty a very small bougie was incompletely stopped; theII troduced ; after this had been kept conthe orifice till the next time of passed, and a poultice was applied to the wound, which had now become making water, it was replaced by a larger considerably inflamed and swelled. A slight bougie, and in four days the urethra ad-

hemorrhage

but it had urine freely

had taken

now

stantly in

mitted a common-sized bougie. At the end of a fortnight this was discontinued for 24 hours; at the close of which short the urethra was again found very conlate. siderablv contracted ; the bougie was again With regard to the necessity of intro-the to, and it has been constantly reducing a bougie or tube to prevent con-1tained till the 12th of September, a period I of traction of the orifice of the urethra after nearly a month since its first introtheoperation, in ordinary cases, surgeons: duction. do not appear to be unanimous. The late From the following passage in the lecture experienced Mr. Hey, of Leeds, advocates above quoted of Mr. Lawrence,-" The the occasional introduction of a bougie ; operation is very simple ; in the first place, vide " Practical Observations in Surgery," you cut circularly round the integuments chap,. xiv, on cancer of the penis. Sir A. of -the penis, and when those have reas far as possible, you cut through Cooper says-" When the surface begins to granulate, a piece of bougie, two inches the body of the penis ; the integuments long, is to be worn constantly in the urethra, will then be loose enough to admit of their to prevent its contraction, otherwise it being brought together over the stump of the gradually closes as the wound heals, and penis,"-it would appear, that he thinks it produces retention of urine." Vide hisadvisable to save as much of the integulectures by Tyrrell,* vol. 2, p. 324. Mr. meuts as possible. As far as the present case Lawrence, no mean authority, in his 75thallows me to judge, I think the preservation in of the penis, lecture, as reported in THE LANCET, vol. 2, of P. 771, advances a different opinion. These not only unnecessary, but, as Sir A. Cooper are his words :-" I have never found it observes," a great evil, by preventing a tree necessary in amputation of the penis to do escape of the urine." The late Mr. Pearthat which is recommended by most system- son was likewise of this opinion. Vide his atic writers; that is, to introduce a bougie " Practical Observations on Cancers," page or catheter to keep the remaining portion of 103. It is due to Mr. Lawrence further to the urethra open. The truth is (continues observe, that Mr. Pearson, in the same l4lr. Lawrence), that this proves an addi- work, disapproves introducing cannuls in tional irritation; the patient makes water this operation, as painful and unnecessary. It may be perceived, that 1 attempted to very well after the operation, and the introduction of such a substance creates an un- preserve no integuments in the above case; easiness which is not at all called for, so thatyet they appear to overlap the extremity of the stump so redundantly as not to offer you may dispense with the bougie great safety." This I considered a fa- any impediment to the complete erection of vourable opportunity of ascertaining thethe penis in future. merits of the treatment inculcated by either Llandovery, Sept. 13th, 1832. of the above eminent surgeons,whose opinions are likelyto influence the practice of the rising part ofthe profession, and not liking to give EXTRACTION OF CALCULI my young- patient any unnecessary pain, I

hemorrhage returned two or three times, generally in the night, but the inflammation and swelling soon subsided, the bleeding disappeared, and the surface began to granu-

time

recur ed I tracted

integuments

amputation

with

’

’

resolved to

adopt Mr. Lawrence’s practice.

FROM THE

BLADDER,

BY

The stump was simply dressed with spermaceti ointment, which was changed each WEISS’S URETHRA DILATOR. time it became necessary to pass urine ; and To the Editor of THE LANCET. as the boy seemed to long to see his parents, who lived about four or five miles in the SIR,—I beg, through the medium of your country, he was allowed to go home. When valuable publication, to add my testimony he returned home, however, at the end to that of Mr. Brougbam, surgeon, of Falof about nine days, I found the wound mouth, whose communication you published nearly healed, and the orifice of the urethra in July last, in favour of Weiss’s urethra so contracted, that the point of a very small dilator, in the extraction of calculi from the probe could hardly be introduced, and had female bladder. the above treatment been persisted in a few Mary Thayer, ætat. 20, of chlorotic habit, days longer, I am convinced that complete consulted me in Feb. 1830, with symptoms retention would have taken place. With characterisingstone in the bladder, for which I was induced to prescribe various alkaline medicines, but with temporary refrom THE LANCET.—ED. L. Copied verbatim

771

the symptoms, after two weeks dura- I tion, returned in a most aggravated form ; therefore, seeing no other alternative, I introduced a sound, and proved the diagnosis

lief ;

to be correct. Having explained the nature of her case, the patient felt anxious to have

sequently, it

is reasonable to suppose that Weiss’s urethra dilator will, I should say, in every case, supersede the operation by the knife in calculi of the female hladder. I have the honour to be, Sir, your obedient servant, JOSEPH LOVEGROVE, M.R.C.S. Horsham, Sept. 13, 1832.

relief afforded as speedily as possible, I therefore proposed an operation by Weiss’s urethra dilator, to which she readily consented, and which accordingly took place on the following morning. The patient being ON THE placed nearly in the usual position for lithotomy, I introduced the dilator, and ANTISEPTIC PROPERTIES continued gradually to expand the blades, until they were separated to their greatest OF THE extent, about an inch and a half, whicii occupied about forty minutes. Having al- HYDROCHLORATE OF TIN. lowed the dilator to remain in the urethra By Dr. TAUFFIER, of Strasburg. twenty minutes, I withdrew it, when, to my great satisfaction, the natural efforts of the bladder expelled a calculus of the size of ALCOHOL, which has hitherto been genea walnut, without materially increasing the used in the preservation of animal s.ub. severity of the patient’s sufferings. Onstances, offers many inconveniences, which, bed, forty drops of tinct. in some instances, may render its antibeinginplaced inmist. camph. opii iss were given. On putrid properties nearly useless. Without visiting her next morning, I found she had speaking of the high price of this liquid, renders its employment very expassed a comfortable night, having had several hours refreshing sleep; felt easy; pensive, especially in putting up cf large tongue clean; pulse 87 ; skin moist ; bowels anatomical specimens, it would be sufficient act open since the operation. Ordered to point out the almost disorganising action which it exercises upon the animal tissues, OZ. ricini 3vj ; to demonstrate the want of a menstruum Liq. potasste gtt. XXX ;a does not present these disadvantages. which Aq. distill. j. Various substances have already been proIn the evening her bowels were comfort- posed to replace the alcohol, but none havq ably relieved; passed her urine several as yet been found to merit a very marked times with less pain than before the opera- preference. tion. The substance of culinary salt, of salt of From this time her health gradually im- nitre, of alum, of sulphate of zinc, which proved, and for three weeks everything havebeen recommended as retarding putrewent on in an uninterrupted way towards faction, oppose but a feeble bariier to the recovery, when she began to experience disorganization of the parts. pain in the region of the left kidney, in- Corrosive sublimate preserves, it is true, creased by pressure and motion, difficulty animal substances from putrid decompoof making water, pain and numbness of the sition, but it hardens and discolours these leg and thigh-in short, every symptom matters, and finally renders them indistinct denoting stone in the bladder had again ap- by a chemical action, which it exercises on peared. To enumerate them would be merely them. Many examples have also proved, Suffice it to say that the employment of this mercurial salt a work of supererogation. they were of an aggravated form. The pa- is not without danger to the operator. tient expressing her belief that stone had The persulphate of iron in solution has again passed from the kidney into the blad- also been recommended as an antiseptio der, and findingits natural efforts insuffi- liquor, but it has the inconvenience of cient for its expulsion, I, at her earnest de- covering the parts to be preserved, with a sire, had recourse to the operation in the crust of sub-sulphate and oxide of manner above detailed, which was repeated To establish this fact, I used a soluthree different times, at intervals varying tion of the trito-sulphate of iron, which had according to the urgency of symptoms ; the for three hours been exposed to the contact each time after the operation, of the air. Some musculJr flesh, which I expelled two, and sometimes three calculi. immersed in this liquid, resisted putrefacfrom the size of a walnut to that of a hazel tion for eleven months; but it became nut. I have not since had occasion to use covered with a coatingof sub-sui phate of the dilator, and feel pleasure in saying the iron which prevents the distinguishing of patient has still the power of retaining herthe organic structure. The liquor becomea urill. as well as before the operation, con. and in lieu of the trito-sul-

rally

which

-

yellow iron.

bladder, at

decolorated,