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ON THE RECURRENCE OF STONE AFTER THE OPERATION OF LITHOTRITY. CASE RELATED BY A PATIENT.
173 Twelve o’clock. Bowels not relieved. uneasiness in svrallowing, with difficulty in separating the teeth, pain behind the ster- (Ordered him two drops of ol. croton in muo. num and at the pit of the stomach towards the tacacim, iss. st. sumend. This had the deI effect; the spasms somewhat abated. vertebrae; muscles of the neck and abdomen,sired the muscles of the abdomen becoming quite Six o’clock. The spasms returned with
(I
hard as a board, the muscles of the limbs iincreased violence. The pulse very feeble 1 and face likewise becoming affected withbut quick, from 100 to 110 and 120, which 1 tetanic spasm ; the features were drawn had been the case throughout the disease, into a peculiar grin or laugh. I immedi-with a dark furred tongue and great thirst. ately examined the wound ; finding it had Had recourse to the opium, camphor, and 1 with opening mixture. put on a livid colour, with some pain shoot- hyd., Ten o’clock. Slightly relieved from pain. ing up the leg, I opened the wound freely, and applied sp. terebinth, with tinct. opii, Continue the draughts and embrocation as and ordered the poultice to be continued before. 12. Eight o’clock. Morning. The sympwith the following medicine :— toms much abated ; had had some sleep R Pulv. opii, gr. ii; during the night, and felt less pain and Camphor, gr. v; Hyd. sub., gr, v. M. f. pulv. capt. stifrness in the muscles of the face and as
neck ; the muscles
omni hora.
:a,
Pufv. rhue, 3ss;
much better ; able
PuZv.jaZap, 3ii;
ill. sennae, :5i,i; Magnes. sulplt,., vi.
of the abdomen not
so
tense; the bowels freely open; the stools water, beef tea, &c.
M. f. haust. cine
as
a little wine and Continued the medi-
to take
before.
12. Ten o’clock. Passed a better night; pulv. less spasm ; bowels relieved ;able to take IP, Lin. sopon., i;; a little toast and tea for breakfast. ConTinct. opii, i. M. f. embroeatio. tinued the powder and mixture. The face, neck, and throat. to be conFour o’clock. Much better; pulse 96. stantly rubbed, which was done day and Ordered him the sulph. quin. in three-grain ii. cap
i,
ornni hora
cum
the medicine continued every hour doses every three hours. Continued the for three doses during the night. twice a day. 10. Seven o’clock in the morning. He suppos. 13. Continues to improve. Repeated the had passed a distressing night. The bowels slightly relieved. Continued the same medi- sulph. 14. Passed a good night. Continues the cine every two hours, instead of every hour. with opening medicine. One o’clock. I called in my friend Mr. sulph. quinin. 15. Better. 16. Ditto. Callaway. We found him more tranquil, 17. Better. Directed for him, the rust of with less anxiety about the countenance; him the bowels had been freely relieved by this iron, ss three times a day. Ordered into the country, Devonshire, to recruit time ; the stools as black as pitch ; con- his strength, &c. &c. tinued the terebinth. to the wound, with Broad Street, Horselydown. 8, poultice, and ordered the following medi. cine:— Appr. suppos. recto pil. sapon. cum opii, i R Morphine, gr. ss ; ,4cid. acet. fort., ss; ON THE RECURRENCE OF STONE AFTER THE Spt. ather. sulph. gtt. xxx OPERATION OF LITHOTRITY. Mist. camph., iss. M. f. haust. 3tia quaq. hora sumend. Rep. embroCASE RELATED BY A PATIENT. catio. R Spt. terebinth, ;; To the Editor of THE LANCET. OZ. ricini, 3i ;; f. enema. M. Muc. acacire, vi. SIR,—In one of your late Numbers you Eight o’clock. Evening. Continue the published the details of a case of stone in draught and embrocation, with a blister to the bladder, which I treated successfully by the nape of the neck. Enema and suppos., the Civialian operation, and which I read before the Westminster Medical Society. with an opening draught. 11. Seven o’clock. Morning. RestlessThis case was interesting from the circumnight ; had several very severe spasms ; nostance of the patient having undergone, three sleep ; the bowels confined. Rep. enema;vears before, the operation of lithotomy. It was the second case of recidive calculus rep. suppos. which I had operated on since my arrival in R Pulv. scammon., i; England; and as the patient, Mr. Heath, Inf. sennæ, iss; .41agnes. sulph., iv. M. f. haust.had no objection to such a course, I felt etat. eumendus. myself called upon, in presenting him to the
night ;
174
to offer a few observations, with at mitted to lithotomy ; the stone was of midcompare both operations. Thesedling size ; my confinement was short. In observations were not given as a full and 1824, I delivered myself of a calculus, of complete parallel between lithotrity and li- the size of a walnut.* After having made
Society,
view
to
.
thotomy ; they merely embraced a few ofF the incision necessary for the extraction of the principal points, in simple cases of cal-the stone, I passed in my fingers and brought
culus in the bladder, in which these opera- it out; it was lodged close bv the neck of the intertions stand contrasted. I shall now detailthe bladder, in a cavity another case, which occurred in our practicenal orifice of the last incision, which had at Paris, and which exhibits a very remark-not entirelv cicatrized on the inside. I reable instance of the reproduction of calcu-covered from this operation in three weeks. lus after operation. My object in relating: These several operations, performed on parts these cases is not solely to record the fact: which were constancy intlamed, joined to of cure by lithotrity. In the former I com- the extreme nervous irritability of my conboth operations with respect to pain stitution, have frequently aroused in me sufpared and danger; in the present, I shall considert’erings which had been only luiled momen. an objection taken against lithotrity, on the tarily. This year, for the seventh time, score of liability to leave fragments of stone 1 became a prey to the relentless tortures in the bladder, which would form a nuclei of this cruel affection, from which I had for other calculi. The subject of the pre- already suffered so much; and the recolleesent case, M. Clever de Maldigny, was him- tion of the trials I had undergone would self a surgeon, and the relation of it is here have more than shaken my courage, if L had transcribed in his own words, as commu- not been led to hope for succour in litho. nicated by him to the Royal Academy oftrity. But my confidence in its efficacy was Sciences :suddenly checked by the contradictory state"I am but 27 years of age, yet I have ments which reached me, and the port’of been already seven times afflicted with safety which was in sight seemed to vanish ; stone. I was first cut at Luneville, in 1816. however, the just terror with which lithoThe calculus which was removed from my tomy inspired me did not allow me to hesiladder on that occasion was broken during tate. I would not submit at once to the extraction; and in the following yar, application of a method with which I was without having experienced any respite from so imperfectly acquainted, but, far from remy sufferings, I was again eut, and two large jecting it, I resolved to study it, and be stones were extracted. After this second mftuenced with regard to it by my own operation, I continued for a considerable judgment alone.I accordingly aiten(le(i time without a return of my complaint. I the practice of Dr. Civiale ; I saw him opehowever suffered occasionally from aydor vesicæ;the urine was sedimentous, and * There are several instances in which patients charged with mucosity ; I never experienc- have cut themselves for stone. Even the first ed any nephritic pains whatever. In 1818, attempts at tbe comminutive or lithotritic method were made by patients ; viz. the Monk of Citeaux and I was again cut at Nancy; the operation, Colonel Martin. A case is related by George Tobias which was very laborious, lasted more than Durr, m the German Ephemerides, of a saddler, who half an hour, and was followed by the most having been cut in his youth, BBas again afflicted with stone fifteen after. He felt pain in the alarming symptoms. An inflammation of perineum, in the years situation of the old wound ; he the most violent character was kindled in opened the cicatrix with his knife, and extracted the bladder, which was soon communicated from it a stone measuring three inches long and two broad; he did well. Tulpius in his to the abdomen. The third day after the nearly Obs. Med. relates the case of a locksmith who abundant operation,a very haemorrhage took having been twice cut for stone, performed the on himself the third time. One of his place from one of the arteries that had been operation brothers held the scrotum. He steadied the cut ; this loss of blood was sn considerable stone with his up left hand, and opened the perineum that my life was in the greatest peril ; it with three incisions, and alter enlarging the wonnd abated for the moment the inflammatory with his fingers, a stone of the size of a hen.egg out of itself. In the Memoirs of the Royal symptoms, but they soon reappeared with dropped SocIety of Montpellier, there is an account ot a increased violence ; the stomach and brain shepherd who suffered from a stone in the bladder, participated in the excitement ; I became which he could find no surgeon bold enough to for. An abscess formed in the perineum delirious. These symptoms yielded to a operate and spontaneously in three diiterent places. copious vomiting of blood, after my surgeon The opened shepherd enlarged one of the openings with his had ceased to entertain the feast hope of fingers, through which he extracted a stone which weighed three ounces. There were three living my recovery. By this terrible operation, worms attached to the stone. The opening became the issue of which had so nearly proved fatal, and all the urine was voided through it tistulous, I was confined to bed for two months, and ever afterwards. In 1789 there was a good deal spoken about an individual ot Troyes who had been my subsequent convalescence was exceed- for long time a sufferer from stone, and who had ingly slow. In 1820, I was cut at Stras-, cut ahimself four times. In the Ilrst attempts he bourg; a small stone was extracted ; my failed, but he at last succeeded in ridding himself I Letter on Lilhotrity. of In the stone.—Civiale’s 1823,1 again recovery was quick.
formed by
ts
sub-
175
led to death which the happy results I through successive crises of anguish and of which soon decided my choice. exhaustion, made it a law with medical men could I act otherwise1had witnessed not to exhibit the reality, but through a such striking examples of its benefits ; I focus of hope and consolation. No one can had seen five fellow-sufferers relieved by deny the obligations which humanity owes application. (Dr. Clever here gives their to those eminent men, ancient and modern, names.) Surely, less than this would have who, by their labours, have shed on this sufficed to subdue the doubts of a poor branch of surgery the lights of an admirable ferer, who might be said to have counted perfection. Who can be so senseless as to the years of his existence by dreadful epochs blame them for reverses which are inherent of sufferina. The cures which I had seen in the operation, and not attributable to the effected while I was myself under treat- operators ? I am not so unjust ; and in this ment gave me confidence in the result, as it sketch I take pleasure in adding my feeble regarded myself, and my hope has not been expression of homage to those which such vain. The first sitting took place on the distinguished talents deserve. But, con20th April ; a lithotrite, two lines and a vinced that the majority at present, and
tate,
and I became convinced of the precious tures from misery
advantages
of
a
only
method,
How
itsi
i
suf-
I ,e
I was introduced into my almost the totality, at no distant period, of the was soon bladder, seized ; it was calculous patients, may be rescued from the stone friable and small ; it was instantly crushed ; knife, 1 shall state exactly the odds against some of its fragments were withdrawn in the use of it. The mere preparatory steps for the performance of lithotomy are awful, the lithotrite, and I voided several with my urine. This sitting lasted and excite terror in the mind of the patient. five minutes. So happy a commencement This unfavourable disposition of the mind, increased my confidence ; even the pain of when it does not add to the chances of a the operation had not been so great as fatal termination, too frequently predisposes presumed it would be ;Ino longer enter- t to serious consequences. He who has too tained any apprehensions ; and submit to he cut, sees himself pitilessly whatever it be, no longer disheartens me, bound, hand and foot, and fixed in the most since 1 have for any future occasion such a position. The impossibility in which he is thus placed, of hoping for the simple and certain resource against lithic reproductions. The operation was least condescension to his cnes, gives the continued on the 22nd, with the same in- complement to his terrors, and presages the strument. One of the remaining fragments tortures in store for him, by a painful feelof the stone was seized without difficulty and ing of suffocation. For though the instrucrushed ; some fragments were extracted in ments are carefully kept out of sight, he the lithotrite, others were expelled with the knows that deep incisions are to be made, urine. On the 27th, the pain caused by the that instruments are to be passed into his pres-ence of the stone in the bladder still bladder through a large wound, the dangers continued ; it had even become more acute. of which are exaggerated by his fears. In On examination the bladder was still found lithotrity, on the contrary, every-thing teuds to contain some fragments of stone; three to reassure him, he sees the instrument, of them were crushed and extracted. On the innocuity of its mode of action is exthe 28th, an exploration was made, but the plained to him, the idea of a speedy desensibility of the bladder was such as to liverance supports his drooping courage, cause the operation to be deferred. On the and he places himself with perfect tran1st of May I still suffered in malting water; i in the proper position, persuaded that he shall enjoy perfect liberty of his I begged M. Civiale to make another and that the operator has the power several fragments were extracted. that moment all the symptoms of stone inInof suspending his labours at the mere menthe bladder ceased. tion of the pain his manoeuvres may occa’ Lithotomy is too well known to require sion. In lithotomv, the duration of the long; despite of the any additional light to be thrown on it from operation may be me ; however, as I believe there is no per- talent of an expert operator, parts essential son better qualified than myself to establish to life will be occasionally injured ; the inor of the ina comparison between this frightful opera- troduction of the tion and the Civialian method, I shall en- struments necessary for the extraction of deavour to trace a parallel of both. As long the stone, create the most excruciating pain. as a deplorable necessity limited art to the The bladder emptied of fluid contracts on too precalious chances of lithotomy, to ex- the stone, and sometimes embraces it so pose the misfortunes which accompany it completely as to conceal it from the touch. would have been an act of the most revolt- In most cases, great obstacles prevent the ing cruelty. The frightful perspective re- stone from being seized in the position deserved for calculous patients, the praise- sired ; but when the stone is large, and worthy desire of rescuing our fellow-crea- there is a disproportion between its size
half in diameter,
i
I others about I I
my futurity,
I these’inconvenient
quillity
search ;
Fromlimbs,
very
fingers,
176 consists of phosphate of lime or uric acid. It should be further observed, when the dishas not subsisted for a long time, and the bladder contains several small calculi, that these may be co-existent with others the kidneys. Under such circumstances, ureters through which the calculi in the bladder have descended, are enlarged. If an operation be now performed for their extraction, it will be little wonder that the disease shall reappear soon after, and that nephritic pains, seeing that the prftome,-how infinitely trifling compared to vious dilatation of the ureters prepares the for the descent of those still remaining the mortal anguish the unhappy sufferer must endure, under the destructive efforts in the kidneys. It is not my object, how. of the blood-stained hands which belabour ever, in arguing on the recidive state of him ! It would be superfluous to defend the culeulus, to overlook the well-grounded lithotritic method against the reproaches hope which is entertained of our being at which have been wrongfully addressed to it; ’, some time or other enabled to prevent the a careful examination of the instruments, I return of this disease, by modifying the se. and the repeated application of them in my cretion of urine. I have the honour to be presence, have convinced me that it is exYour obedient servant, empt from all dangerous consequences ; but it is not so in the cutting operation." (Here W. B. COSTELLO. Mr. Clever enters into the consideration of St. Martin’s Lane, London, the dangers of lithotomy, which, as they April 26th, 1831. would extend this paper to au inconvenient length, I think it unnecessary to repro-
and the diameter of the aperture through which it is to be extracted, what fatal la. ceration must be resorted to ! If the calculi be numerous, how fatiguing the operation is for the surgeon, and, a fortiori, how excessively terrible for the poor patient! Lithotrity regulates the periods of its application accordingto the wishes of the patient, and may be adjourned at pleasure. True it is, that its application is not exempt from pain; but how trifling is this pain eompared with the cruel lacerations of thelitho-
ease
in the
without way
60,
duce.) The
point
which the foregoing case is the reproduction or of this disease. The objec-
on
JOHN LONG AND DR. RAMADGE.
particularly bears,
recidive state tion is taken against lithotrity
on the ground To tite Editor of THE LANCET. of the probability that some fragments of I the calculus may be left in the bladder after SIR,—Every member of our profession, the operation, and that these mav become who has the least regard for his character l i the nuclei of other calculi. In this objec- on the score of honesty, propriety, or, I I tion it is not considered how much add, common decency, will, I am sure, morei may or a perfect sounding exploring instrument be deeply indignant at the course Dr. the lithotrite is, than the common curved Ramadge has pursued in defence of John sound. By means of the lithotrite, not only St. John Long. Permit me, however, to can a portion of calculus no bigger than a suggest that the wisest plan is to leave both grain of wheat be discovered in the blad- these highly honourable and respectable der, but it may be, by this instrument, persons to fiud their own level. The former crushed or extracted at the same time. Re- has already been twice introduced to public cidive calculus is not so unfrequent as it is notice at the bar of the Old Bailey, and I generally supposed to be. Many patients do not doubt that the issue of any observahave been twice cut for stone ; but how tions you may make, in exposition of the much greater this number would have been, i conduct of the latter, will be of utility to if lithotomy had not been so often fatal him, by acquiring him that notoriety it is when performed on those who submitted to his object to obtain. From the medical proit for the second, third, and fourth time !:’, fession, Dr. Ramadge’s character will alNow, as lithotrity shelters those who sub- i ways receive the immensf* respect it merits ; mit to it from the same chances of morta- while the experience of an individual scarcelity, the reproduction of stone must neces- ly in the meridian of life, who states he has sarily be more frequent, because it may be opened " more than a thousand bodies of resorted to in the majority of those cases in consumptive persons alone," cannot fail of which the cuttlllg operation would have havingits due weight with the public. caused death. Facts like these show how I am, Sir, fallacious it would be to attribute to the new Your obedient servant, method the return of a disease, the cause of FRED. SALMON. which is unknown, and which, in spite of 12, Old Broad-street, all the speculations of physiologists, is so April 30, 1831. frequently reproduced with frightful promp-
li
I
titude, particularly
when the concretion
(I
hard as a board, the muscles of the limbs iincreased violence. The pulse very feeble 1 and face likewise becoming affected withbut quick, from 100 to 110 and 120, which 1 tetanic spasm ; the features were drawn had been the case throughout the disease, into a peculiar grin or laugh. I immedi-with a dark furred tongue and great thirst. ately examined the wound ; finding it had Had recourse to the opium, camphor, and 1 with opening mixture. put on a livid colour, with some pain shoot- hyd., Ten o’clock. Slightly relieved from pain. ing up the leg, I opened the wound freely, and applied sp. terebinth, with tinct. opii, Continue the draughts and embrocation as and ordered the poultice to be continued before. 12. Eight o’clock. Morning. The sympwith the following medicine :— toms much abated ; had had some sleep R Pulv. opii, gr. ii; during the night, and felt less pain and Camphor, gr. v; Hyd. sub., gr, v. M. f. pulv. capt. stifrness in the muscles of the face and as
neck ; the muscles
omni hora.
:a,
Pufv. rhue, 3ss;
much better ; able
PuZv.jaZap, 3ii;
ill. sennae, :5i,i; Magnes. sulplt,., vi.
of the abdomen not
so
tense; the bowels freely open; the stools water, beef tea, &c.
M. f. haust. cine
as
a little wine and Continued the medi-
to take
before.
12. Ten o’clock. Passed a better night; pulv. less spasm ; bowels relieved ;able to take IP, Lin. sopon., i;; a little toast and tea for breakfast. ConTinct. opii, i. M. f. embroeatio. tinued the powder and mixture. The face, neck, and throat. to be conFour o’clock. Much better; pulse 96. stantly rubbed, which was done day and Ordered him the sulph. quin. in three-grain ii. cap
i,
ornni hora
cum
the medicine continued every hour doses every three hours. Continued the for three doses during the night. twice a day. 10. Seven o’clock in the morning. He suppos. 13. Continues to improve. Repeated the had passed a distressing night. The bowels slightly relieved. Continued the same medi- sulph. 14. Passed a good night. Continues the cine every two hours, instead of every hour. with opening medicine. One o’clock. I called in my friend Mr. sulph. quinin. 15. Better. 16. Ditto. Callaway. We found him more tranquil, 17. Better. Directed for him, the rust of with less anxiety about the countenance; him the bowels had been freely relieved by this iron, ss three times a day. Ordered into the country, Devonshire, to recruit time ; the stools as black as pitch ; con- his strength, &c. &c. tinued the terebinth. to the wound, with Broad Street, Horselydown. 8, poultice, and ordered the following medi. cine:— Appr. suppos. recto pil. sapon. cum opii, i R Morphine, gr. ss ; ,4cid. acet. fort., ss; ON THE RECURRENCE OF STONE AFTER THE Spt. ather. sulph. gtt. xxx OPERATION OF LITHOTRITY. Mist. camph., iss. M. f. haust. 3tia quaq. hora sumend. Rep. embroCASE RELATED BY A PATIENT. catio. R Spt. terebinth, ;; To the Editor of THE LANCET. OZ. ricini, 3i ;; f. enema. M. Muc. acacire, vi. SIR,—In one of your late Numbers you Eight o’clock. Evening. Continue the published the details of a case of stone in draught and embrocation, with a blister to the bladder, which I treated successfully by the nape of the neck. Enema and suppos., the Civialian operation, and which I read before the Westminster Medical Society. with an opening draught. 11. Seven o’clock. Morning. RestlessThis case was interesting from the circumnight ; had several very severe spasms ; nostance of the patient having undergone, three sleep ; the bowels confined. Rep. enema;vears before, the operation of lithotomy. It was the second case of recidive calculus rep. suppos. which I had operated on since my arrival in R Pulv. scammon., i; England; and as the patient, Mr. Heath, Inf. sennæ, iss; .41agnes. sulph., iv. M. f. haust.had no objection to such a course, I felt etat. eumendus. myself called upon, in presenting him to the
night ;
174
to offer a few observations, with at mitted to lithotomy ; the stone was of midcompare both operations. Thesedling size ; my confinement was short. In observations were not given as a full and 1824, I delivered myself of a calculus, of complete parallel between lithotrity and li- the size of a walnut.* After having made
Society,
view
to
.
thotomy ; they merely embraced a few ofF the incision necessary for the extraction of the principal points, in simple cases of cal-the stone, I passed in my fingers and brought
culus in the bladder, in which these opera- it out; it was lodged close bv the neck of the intertions stand contrasted. I shall now detailthe bladder, in a cavity another case, which occurred in our practicenal orifice of the last incision, which had at Paris, and which exhibits a very remark-not entirelv cicatrized on the inside. I reable instance of the reproduction of calcu-covered from this operation in three weeks. lus after operation. My object in relating: These several operations, performed on parts these cases is not solely to record the fact: which were constancy intlamed, joined to of cure by lithotrity. In the former I com- the extreme nervous irritability of my conboth operations with respect to pain stitution, have frequently aroused in me sufpared and danger; in the present, I shall considert’erings which had been only luiled momen. an objection taken against lithotrity, on the tarily. This year, for the seventh time, score of liability to leave fragments of stone 1 became a prey to the relentless tortures in the bladder, which would form a nuclei of this cruel affection, from which I had for other calculi. The subject of the pre- already suffered so much; and the recolleesent case, M. Clever de Maldigny, was him- tion of the trials I had undergone would self a surgeon, and the relation of it is here have more than shaken my courage, if L had transcribed in his own words, as commu- not been led to hope for succour in litho. nicated by him to the Royal Academy oftrity. But my confidence in its efficacy was Sciences :suddenly checked by the contradictory state"I am but 27 years of age, yet I have ments which reached me, and the port’of been already seven times afflicted with safety which was in sight seemed to vanish ; stone. I was first cut at Luneville, in 1816. however, the just terror with which lithoThe calculus which was removed from my tomy inspired me did not allow me to hesiladder on that occasion was broken during tate. I would not submit at once to the extraction; and in the following yar, application of a method with which I was without having experienced any respite from so imperfectly acquainted, but, far from remy sufferings, I was again eut, and two large jecting it, I resolved to study it, and be stones were extracted. After this second mftuenced with regard to it by my own operation, I continued for a considerable judgment alone.I accordingly aiten(le(i time without a return of my complaint. I the practice of Dr. Civiale ; I saw him opehowever suffered occasionally from aydor vesicæ;the urine was sedimentous, and * There are several instances in which patients charged with mucosity ; I never experienc- have cut themselves for stone. Even the first ed any nephritic pains whatever. In 1818, attempts at tbe comminutive or lithotritic method were made by patients ; viz. the Monk of Citeaux and I was again cut at Nancy; the operation, Colonel Martin. A case is related by George Tobias which was very laborious, lasted more than Durr, m the German Ephemerides, of a saddler, who half an hour, and was followed by the most having been cut in his youth, BBas again afflicted with stone fifteen after. He felt pain in the alarming symptoms. An inflammation of perineum, in the years situation of the old wound ; he the most violent character was kindled in opened the cicatrix with his knife, and extracted the bladder, which was soon communicated from it a stone measuring three inches long and two broad; he did well. Tulpius in his to the abdomen. The third day after the nearly Obs. Med. relates the case of a locksmith who abundant operation,a very haemorrhage took having been twice cut for stone, performed the on himself the third time. One of his place from one of the arteries that had been operation brothers held the scrotum. He steadied the cut ; this loss of blood was sn considerable stone with his up left hand, and opened the perineum that my life was in the greatest peril ; it with three incisions, and alter enlarging the wonnd abated for the moment the inflammatory with his fingers, a stone of the size of a hen.egg out of itself. In the Memoirs of the Royal symptoms, but they soon reappeared with dropped SocIety of Montpellier, there is an account ot a increased violence ; the stomach and brain shepherd who suffered from a stone in the bladder, participated in the excitement ; I became which he could find no surgeon bold enough to for. An abscess formed in the perineum delirious. These symptoms yielded to a operate and spontaneously in three diiterent places. copious vomiting of blood, after my surgeon The opened shepherd enlarged one of the openings with his had ceased to entertain the feast hope of fingers, through which he extracted a stone which weighed three ounces. There were three living my recovery. By this terrible operation, worms attached to the stone. The opening became the issue of which had so nearly proved fatal, and all the urine was voided through it tistulous, I was confined to bed for two months, and ever afterwards. In 1789 there was a good deal spoken about an individual ot Troyes who had been my subsequent convalescence was exceed- for long time a sufferer from stone, and who had ingly slow. In 1820, I was cut at Stras-, cut ahimself four times. In the Ilrst attempts he bourg; a small stone was extracted ; my failed, but he at last succeeded in ridding himself I Letter on Lilhotrity. of In the stone.—Civiale’s 1823,1 again recovery was quick.
formed by
ts
sub-
175
led to death which the happy results I through successive crises of anguish and of which soon decided my choice. exhaustion, made it a law with medical men could I act otherwise1had witnessed not to exhibit the reality, but through a such striking examples of its benefits ; I focus of hope and consolation. No one can had seen five fellow-sufferers relieved by deny the obligations which humanity owes application. (Dr. Clever here gives their to those eminent men, ancient and modern, names.) Surely, less than this would have who, by their labours, have shed on this sufficed to subdue the doubts of a poor branch of surgery the lights of an admirable ferer, who might be said to have counted perfection. Who can be so senseless as to the years of his existence by dreadful epochs blame them for reverses which are inherent of sufferina. The cures which I had seen in the operation, and not attributable to the effected while I was myself under treat- operators ? I am not so unjust ; and in this ment gave me confidence in the result, as it sketch I take pleasure in adding my feeble regarded myself, and my hope has not been expression of homage to those which such vain. The first sitting took place on the distinguished talents deserve. But, con20th April ; a lithotrite, two lines and a vinced that the majority at present, and
tate,
and I became convinced of the precious tures from misery
advantages
of
a
only
method,
How
itsi
i
suf-
I ,e
I was introduced into my almost the totality, at no distant period, of the was soon bladder, seized ; it was calculous patients, may be rescued from the stone friable and small ; it was instantly crushed ; knife, 1 shall state exactly the odds against some of its fragments were withdrawn in the use of it. The mere preparatory steps for the performance of lithotomy are awful, the lithotrite, and I voided several with my urine. This sitting lasted and excite terror in the mind of the patient. five minutes. So happy a commencement This unfavourable disposition of the mind, increased my confidence ; even the pain of when it does not add to the chances of a the operation had not been so great as fatal termination, too frequently predisposes presumed it would be ;Ino longer enter- t to serious consequences. He who has too tained any apprehensions ; and submit to he cut, sees himself pitilessly whatever it be, no longer disheartens me, bound, hand and foot, and fixed in the most since 1 have for any future occasion such a position. The impossibility in which he is thus placed, of hoping for the simple and certain resource against lithic reproductions. The operation was least condescension to his cnes, gives the continued on the 22nd, with the same in- complement to his terrors, and presages the strument. One of the remaining fragments tortures in store for him, by a painful feelof the stone was seized without difficulty and ing of suffocation. For though the instrucrushed ; some fragments were extracted in ments are carefully kept out of sight, he the lithotrite, others were expelled with the knows that deep incisions are to be made, urine. On the 27th, the pain caused by the that instruments are to be passed into his pres-ence of the stone in the bladder still bladder through a large wound, the dangers continued ; it had even become more acute. of which are exaggerated by his fears. In On examination the bladder was still found lithotrity, on the contrary, every-thing teuds to contain some fragments of stone; three to reassure him, he sees the instrument, of them were crushed and extracted. On the innocuity of its mode of action is exthe 28th, an exploration was made, but the plained to him, the idea of a speedy desensibility of the bladder was such as to liverance supports his drooping courage, cause the operation to be deferred. On the and he places himself with perfect tran1st of May I still suffered in malting water; i in the proper position, persuaded that he shall enjoy perfect liberty of his I begged M. Civiale to make another and that the operator has the power several fragments were extracted. that moment all the symptoms of stone inInof suspending his labours at the mere menthe bladder ceased. tion of the pain his manoeuvres may occa’ Lithotomy is too well known to require sion. In lithotomv, the duration of the long; despite of the any additional light to be thrown on it from operation may be me ; however, as I believe there is no per- talent of an expert operator, parts essential son better qualified than myself to establish to life will be occasionally injured ; the inor of the ina comparison between this frightful opera- troduction of the tion and the Civialian method, I shall en- struments necessary for the extraction of deavour to trace a parallel of both. As long the stone, create the most excruciating pain. as a deplorable necessity limited art to the The bladder emptied of fluid contracts on too precalious chances of lithotomy, to ex- the stone, and sometimes embraces it so pose the misfortunes which accompany it completely as to conceal it from the touch. would have been an act of the most revolt- In most cases, great obstacles prevent the ing cruelty. The frightful perspective re- stone from being seized in the position deserved for calculous patients, the praise- sired ; but when the stone is large, and worthy desire of rescuing our fellow-crea- there is a disproportion between its size
half in diameter,
i
I others about I I
my futurity,
I these’inconvenient
quillity
search ;
Fromlimbs,
very
fingers,
176 consists of phosphate of lime or uric acid. It should be further observed, when the dishas not subsisted for a long time, and the bladder contains several small calculi, that these may be co-existent with others the kidneys. Under such circumstances, ureters through which the calculi in the bladder have descended, are enlarged. If an operation be now performed for their extraction, it will be little wonder that the disease shall reappear soon after, and that nephritic pains, seeing that the prftome,-how infinitely trifling compared to vious dilatation of the ureters prepares the for the descent of those still remaining the mortal anguish the unhappy sufferer must endure, under the destructive efforts in the kidneys. It is not my object, how. of the blood-stained hands which belabour ever, in arguing on the recidive state of him ! It would be superfluous to defend the culeulus, to overlook the well-grounded lithotritic method against the reproaches hope which is entertained of our being at which have been wrongfully addressed to it; ’, some time or other enabled to prevent the a careful examination of the instruments, I return of this disease, by modifying the se. and the repeated application of them in my cretion of urine. I have the honour to be presence, have convinced me that it is exYour obedient servant, empt from all dangerous consequences ; but it is not so in the cutting operation." (Here W. B. COSTELLO. Mr. Clever enters into the consideration of St. Martin’s Lane, London, the dangers of lithotomy, which, as they April 26th, 1831. would extend this paper to au inconvenient length, I think it unnecessary to repro-
and the diameter of the aperture through which it is to be extracted, what fatal la. ceration must be resorted to ! If the calculi be numerous, how fatiguing the operation is for the surgeon, and, a fortiori, how excessively terrible for the poor patient! Lithotrity regulates the periods of its application accordingto the wishes of the patient, and may be adjourned at pleasure. True it is, that its application is not exempt from pain; but how trifling is this pain eompared with the cruel lacerations of thelitho-
ease
in the
without way
60,
duce.) The
point
which the foregoing case is the reproduction or of this disease. The objec-
on
JOHN LONG AND DR. RAMADGE.
particularly bears,
recidive state tion is taken against lithotrity
on the ground To tite Editor of THE LANCET. of the probability that some fragments of I the calculus may be left in the bladder after SIR,—Every member of our profession, the operation, and that these mav become who has the least regard for his character l i the nuclei of other calculi. In this objec- on the score of honesty, propriety, or, I I tion it is not considered how much add, common decency, will, I am sure, morei may or a perfect sounding exploring instrument be deeply indignant at the course Dr. the lithotrite is, than the common curved Ramadge has pursued in defence of John sound. By means of the lithotrite, not only St. John Long. Permit me, however, to can a portion of calculus no bigger than a suggest that the wisest plan is to leave both grain of wheat be discovered in the blad- these highly honourable and respectable der, but it may be, by this instrument, persons to fiud their own level. The former crushed or extracted at the same time. Re- has already been twice introduced to public cidive calculus is not so unfrequent as it is notice at the bar of the Old Bailey, and I generally supposed to be. Many patients do not doubt that the issue of any observahave been twice cut for stone ; but how tions you may make, in exposition of the much greater this number would have been, i conduct of the latter, will be of utility to if lithotomy had not been so often fatal him, by acquiring him that notoriety it is when performed on those who submitted to his object to obtain. From the medical proit for the second, third, and fourth time !:’, fession, Dr. Ramadge’s character will alNow, as lithotrity shelters those who sub- i ways receive the immensf* respect it merits ; mit to it from the same chances of morta- while the experience of an individual scarcelity, the reproduction of stone must neces- ly in the meridian of life, who states he has sarily be more frequent, because it may be opened " more than a thousand bodies of resorted to in the majority of those cases in consumptive persons alone," cannot fail of which the cuttlllg operation would have havingits due weight with the public. caused death. Facts like these show how I am, Sir, fallacious it would be to attribute to the new Your obedient servant, method the return of a disease, the cause of FRED. SALMON. which is unknown, and which, in spite of 12, Old Broad-street, all the speculations of physiologists, is so April 30, 1831. frequently reproduced with frightful promp-
li
I
titude, particularly
when the concretion