BARAICH DISPENSARY. CASE OP CALCULUS IN THE FEMALE BLADDER. By Assistant-Surgeon Nvnd La.ll Banerjee. Although the following
case
proved unsuccessful,
still
l
deem it sufficiently interesting to record the circumstances of the patient, the details of the operation, the symptoms which succeeded it, and the treatment by which these symptoms were combated. Foola, a middle-aged Hindu female, was admitted into the hospital on the 1st of January 1874, with symptoms which had persisted for two years, and which clearly indicated the presence She was thin and emaciated, and in of stone in the bladder. such a condition as might be expected in a poor badly-nourished woman.
Previous History.?Patient stated that she had been suffering from difficult micturition and agonizing pains in the hypogastric region for the last two years; she had had recourse to native nurses and midwives, but had got no relief. Present condition.?Countenance anaemic and expressive of suffering ; body emaciated ; tongue covered with a thick white fur ; pulse weak and small; lies on her back with knees drawn up; thigh's and clothes constantly wet and smelling offensively of stale urine; the least attempt to change this posture excites an outburst of cries of agony. On examining the bladder in the ordinary way a distinct click could be heard?that of a large calculus ; bowels costive ; appetite pretty fair. Dr. Cromarty attempted to take out the stone by dilating the urethra. As no proper appliances were at hand, an ordinary and fixed in spare ivory pipe was introduced into the urethra situ. This however did not produce the desired object, as tho patient was constantly taking it out. It was therefore determined to operate, the patient having given her full consent. The patient being placed under the influence of chloroform, the urethra was enlarged by means of a blunt pointed bistoury, and on introducing the finger into the bladder the stone was found broken in two pieces, neither of which it was considered practicable to remove through the enlarged opening. It was then determined to cut through the wall of the vagina, and accordingly the two pieces were removed. No haemorrhage occurred after the operation. The stone, which weighed 3| oz., had evidently originally consisted of two distinct calculi, which ultimately had become joined by a facet and a superficial connecting deposit. The fracture of this thin and brittle deposit had caused the stone to separate into two pieces.
244
TH^ INDIAN MEDICAL GAZETTE.
Treatment.?She was ordered plenty of stimulants and sedaand progressed favorably for three days, when suddenly, on the evening of the 4th day, she complained of distressing pains about the genitals and abdomen, and expired on the 5th day of the operation of peritonitis, notwithstanding every care which remedial measures could afford. No post-mortem allowed." Remarks.?This case came at a time when it was almost too The operation offered perhaps relief late to hope for success. from suffering and a faint chance of life. The people of Upper India make up their minds to seek relief at the hospital when the mischief has advanced so far that the chance of recovery i3 almost reduced to a minimum.
tives,
[September 1,
1875.
case
proved unsuccessful,
still
l
deem it sufficiently interesting to record the circumstances of the patient, the details of the operation, the symptoms which succeeded it, and the treatment by which these symptoms were combated. Foola, a middle-aged Hindu female, was admitted into the hospital on the 1st of January 1874, with symptoms which had persisted for two years, and which clearly indicated the presence She was thin and emaciated, and in of stone in the bladder. such a condition as might be expected in a poor badly-nourished woman.
Previous History.?Patient stated that she had been suffering from difficult micturition and agonizing pains in the hypogastric region for the last two years; she had had recourse to native nurses and midwives, but had got no relief. Present condition.?Countenance anaemic and expressive of suffering ; body emaciated ; tongue covered with a thick white fur ; pulse weak and small; lies on her back with knees drawn up; thigh's and clothes constantly wet and smelling offensively of stale urine; the least attempt to change this posture excites an outburst of cries of agony. On examining the bladder in the ordinary way a distinct click could be heard?that of a large calculus ; bowels costive ; appetite pretty fair. Dr. Cromarty attempted to take out the stone by dilating the urethra. As no proper appliances were at hand, an ordinary and fixed in spare ivory pipe was introduced into the urethra situ. This however did not produce the desired object, as tho patient was constantly taking it out. It was therefore determined to operate, the patient having given her full consent. The patient being placed under the influence of chloroform, the urethra was enlarged by means of a blunt pointed bistoury, and on introducing the finger into the bladder the stone was found broken in two pieces, neither of which it was considered practicable to remove through the enlarged opening. It was then determined to cut through the wall of the vagina, and accordingly the two pieces were removed. No haemorrhage occurred after the operation. The stone, which weighed 3| oz., had evidently originally consisted of two distinct calculi, which ultimately had become joined by a facet and a superficial connecting deposit. The fracture of this thin and brittle deposit had caused the stone to separate into two pieces.
244
TH^ INDIAN MEDICAL GAZETTE.
Treatment.?She was ordered plenty of stimulants and sedaand progressed favorably for three days, when suddenly, on the evening of the 4th day, she complained of distressing pains about the genitals and abdomen, and expired on the 5th day of the operation of peritonitis, notwithstanding every care which remedial measures could afford. No post-mortem allowed." Remarks.?This case came at a time when it was almost too The operation offered perhaps relief late to hope for success. from suffering and a faint chance of life. The people of Upper India make up their minds to seek relief at the hospital when the mischief has advanced so far that the chance of recovery i3 almost reduced to a minimum.
tives,
[September 1,
1875.
