THE REMOVAL OF CALCULI FROM THE BLADDER AND URETHRA, WITH LITHOTRITIC AND URETHRAL INSTRUMENTS,

311

straining, but no stone was and from that period he dated evacuated, REMOVAL OF CALCULI FROM THE the existence of a stone in his bladder. BLADDER AND URETHRA, He had often since passed small stones, but he still felt that the first one remained WITH LITHOTRITIC AND URETHRAL behind; he could feel it when sitting. Mr. INSTRUMENTS, Costello sounded him, and as the caDescribed and demonstrated by MR. Cos- theter descended through the membranous part of the urethra, he felt it grate TELLO, at the Webb-street School. upon a stone. The bladder was carefully explored, but no stone detected in that To the Editor of THE LANCET. organ. On withdrawing the catheter, the SIR,—Two lectures have lately been de- same grating was felt in the urethra as upon livered by Mr. Costello, on lithotrity, at its introduction. It was then declared to the the Medical School, Webb-street, before patient that the bladder was considered to Mr. Grainger’s class. On these occasions be free from stone, but that there was a in the passage. As soon as the pathe lecturer expatiated on the history, this opinion, he felt satisfied of progress, and general applicability of this tient operation, sustaining the interest of his its correctness, from his own sensations. An attempt was then made to seize the subject throughout. on an extension stone in this situation, with a three-branch He dwelt of the new mode to the removal of instrument, but without success. The ments of calculi, or small calculi, which passage was free enough beneath the have been arrested in their passage through stone, which occupied its upper surface, the urethra, and the more so, he said, be- to allow the instrument to be placed in cause precept for the guidance of the sur- parallelism with it. The branches were geon’s conduct in such cases had been laid expanded as much as the urethra would down recently in an erroneous but very au- allow, and slight rotatory movements thoritative manner. The writer to were made, but the stone could not be he alluded, in treating of this subject, had made to fall between the branches. Hunstated, that small calculi, or fragments of ter’s forceps were also tried,-the stone calculi, resulting from a lithotriptic opera- could be seized but not detached. A tion, might be arrested in any part of the spoon-like instrument was also tried, but urethra, and that the surgeon’s conduct the stone still remained fixed. with regard to them was to be determined The want of success of these attempts by their situation; all that were posterior ( pressed strongly the alternative of the to the bulb or commencement of the mem f boulottiere. The patient, however, had the branous part of the urethra, were to be most decided repugnance to its employreturned into the bladder if possible; alli ment, and asked for a renewal of the that were anterior to the bulb, being former attempts rather than submit to the within his reach and control, were to be new one. The operator himself was loath extracted. In the first instance, it was to have recourse to it, except as a derniere true that it would sometimes happen that resort, because a fistulous opening might be the foreign bodies could not be forced the result. The urethra does not heal back into the bladder, in which case the kindly when a stone has irritated it for aboutoniere or perineal incision was to be long time, and Mr. Costello, therefore, set had recourse to. Differing as he did toto upon divising another method. He introccelo from this view of the subject, it was duced a bougie, armed at its end with a but just, that he should state the grounds largeknob wax, and having oiled it of his opinion, and this he felt the more well, passed it down to the stone. The impelled to do, as he should at the same wax, softened by the heat of the canal, time develop a principle which must moulded itself upon the stone, and on withdrawn, exhibited the form ef the change our entire practice as regards this branch of the treatment of the calculous stone and its relation to the urethra. With the information thus obtained, he affection. devised the small instrument, which he A few months back he was called to and explained. It was straight, patient of Mr. Griffiths, of Gower-street, residing in Caroline Mews, Bedford-square. and consisted of two pieces, one sliding in Mr. Fairmaner (the patient) was of a the other, and presenting short crotchets gouty diathesis, and had been in the habit of for seizing the stone. The method of using passing small stones occasionally for the it was as follows:-It was passed down last twenty years. About ten years the further extremity of the stone; the he had an unusually sharp attack ; he ago felt wax mould showed that the stone was held as if a stone would come away; there was two folds of the urethra, one holding it a good deal of blood passed at the time, the other anteriorlv, so that it with great

THE

-

stone

heard

particularly

‘

frag-

whom

I

of

being

a

I showed to

by i posteiiorly,

312 was, in

a manner, set in the soft parts. The crotchet was insinuated between the fold and the stone, until the operator felt that it was in naked contact with the stone. The other crotchet was then withdrawn about an inch, and being then advanced towards the other crochet, it stopped on the anterior fold. The space

separating

both

operation

nearly threeoccupied by anterior fold. The ob-

was

quarters of an inch,

now

and

the stone and the ject then was to lift this

cf the anterior crotchet. was

of a few seconds, and afforded an illustration of the value of the instrument, and the soundness of the doctrines established upon it. The dexterity with which the

was

fold on the back The manoeuvre

difficult, but, by correctly observing

the measurement, it was effected. The stone was grasped and extracted, and thus the disagreeable alternative of the peri-

was

performed, greatly

ex-

cited the admiration of the spectator. The large instrument was then passed into the bladder. Many portions of the stone were rapidly reduced, and the patient walked from the theatre apparently suffering but little inconvenience. The clearness with which Mr. C. laid down his principles, and the trouble he took to demonstrate them, merited the thanks of the numerous students who attended, and elicited many expressions of gratitude to Mr. C. for furnishing them the opportunity of becoming personally acquainted with a means by which the dangerous and often fatal operation of lithotomy might in most cases be superseded. I am, Sir, yours truly, WM. ARCHER,

neal incision was averted. The instrument was made to meet this I case ; but several trials since, and one on a child of seven years of age, fully establisbed its efficiency. Mr. Costello, there- I fore, felt confident that the precepts to Student at the Webb Street School. which he alluded would no longer prevail in sound surgery, and as vesical lithotrity Borough, May , 1834. superseded to a great extent the incision of the prostate, for stone in the bladder, so, he said, would urethral lithotrity suCASE OF persede the boutoniere, in cases of small calculi or fragments arrested in DISLOCATION OF THE FEMUR INTO gress through the urethra. THE FORAMEN OVALE. On the 2-)th of April, Mr. Costello rated on a patient in Mr. Grainger’s theBy O. B. BELLINGHAM, M.D., atre. The stone measured rather more than two inches in diameter. It was ra- Member of the Royal Coll. of Surg. in Ireland, and Lecturer on Materia Medica at the School of Anapidly seized and broken. The sitting tomy, Eccles Street, Dublin. lasted about three minutes. On Saturdav the 3rd instant the same IN No. 553 of THE LAxcrT, two cases himself again, having patient walked from the west end of the town toare given of dislocation of the femur into be operated on. He had voided a con- the foramen ovale, which were reduced at siderable quantity of powder and frag-’the London Hospital, and as it is not a ments of the stone since the former sit- very common dislocation, the following ting. Mr. C. stated that he had not inter- notes of a case (which occurred to me in fered with him since he was last beforethe country some years ago, and in,which them, and that the patient had voided twothe reduction was very easily effected) may fragments of considerable size that morn- be worth inserting, in an early No. of that ing. These were shown around. The widely circulating journal. patient having got on the table a catheter Hugh Murray, aged about 55, a labourwas passed; it stopped at the membran ing man, was at work in a gravel pit, near eus part of the urethra. "This," county Monaghan, when Mr. C., "would have been an untoward part of the side, which was undermined, circumstance for our operation had it oc- fell in and buried him up to the neck. curred some time back, but if too much According to his account he was thrown has not been said in praise of our little on his face. I saw him early the next urethral instrument, it will not be an ob- day, when I found that he had a commistacle to my proceeding with the opera- nuted fracture of the shaft of the left fetion now." He then took the instrument, mur, and a dislocation on the right side of passed it to the stone, and, without seem- the head of the bone into the foramen ing to make any search or movement, he ovale, the symptoms of which were as announced that the stone was in the in- follows ;-The knee and foot were a good strument, and that he should remove it separated from the other; the toes entire if the patient did not suffer. Hewere turned out, and the knee was bent; there was a depression where the great then withdrew it gently, and exhibited to the classs. All this was the B?ork cap- be felt in the natural htate,

i

their ope-pro-

presented

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saidCarrickmacross,

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ittrochanter