CASES
OF VESICAL CALCULI.
Pickering, F.R.C.S., Surgeon
By
Charles F.
to the Bristol General
Hospital. Case 1.
18
J. M.,
months, aged hospital, suffering
a
very badly-nourished and puny child, admitted on May 26th into the
was
from acute retention of urine.
The
mother's account was, that it had never been strong, had suffered from no trouble with the water before, and never
passed blood nor complained of pain in micturition. Four days before admission she noticed the child seemed in great pain, and took it to a doctor, who said it had
had
stoppage
of the bowels.
The child continued to get
worse, and for the last two days had not passed any water. On admission, the bladder was found distended
A catheter was passed, and six up to the umbilicus. of water drawn off, which was of foul odour and
ounces
deposited one-third pus (?) on standing. The housesurgeon passed a sound, and thought he felt a stone once, but not again. I saw the child next day; but found it so ill, that I did not care to sound again. Morning temperature, 1020. On the following day, when I next saw the child, it was in articulo mortis. I examined with a sound, without chloroform, but could not detect any stone. The
184
VESICAL
child died risen
a
CALCULI.
few hours afterwards.
continuously
death, and the child had passed The
catheter.
only sign
retention of urine. at
no
no water
of stone in this
I did not examine
by
except by the case
was
the
the rectum,
as
time whilst in the
hospital did the condition of the cutting operation. The death was probacondition which is called, for want of a better
child allow of
bly
The temperature had
since admission to the time of
ever
due to
name,
"
a
a
urethral fever."
Post-mortem Examination.?The and
what
and the
kidneys pelvis of
were
some-
each kidney swollen, enlarged good deal dilated ; in other respects these organs were apparently healthy. The bladder was slightly inflamed, and contained, lying free in its cavity, a curious specimen of vesical calculus, about the size of a bantam's egg, and a
of
a
kind that I have not
The
specimen was one envelope.
thick fibrinous
seen
of
a
described before. hard
and measured two inches in its inch in its shortest. the size of
calculus, enclosed in a weighed 3J drachms, long diameter and one
The whole
The hard stone in the centre
pea, and
was
of uric acid.
The composed envelope was built up in layers of membrane, easily separated from each other, and forming a tough a
was
fibrinous
and compact shell.
occasionally
seen
Fibrinous calculi in the bladder but this
;
different
pathological origin
general,
which
appears to in this
me
case
the
bladder, mucus,"
blood
are
think,
a
calculi
in
clots.
It
that the formation of the thick membrane
is best
entrance
which
fibrinous
usually changed
are
formation: that on
specimen has, from
I
explained by
a
calculus-forming
of
gives
the German view of stone
a
stone or
rise to the
catarrh
is set
foreign body production of
"
up into the
fibrinous
and this forms the adhesive material which binds
VESICAL
CALCULI.
185
together the inorganic salts. In this specimen the adhesive material was deposited, but the salts are absent in the outer layers, and thus prevented the stone being felt by the sound. Case II. A young man, aged 16, was admitted into the hospital, complaining of incontinence of urine. On examination I found a very hard calculus, which I thought This proved to be the was oxalic acid in composition. I proceeded to after a few as admission, when, case, days hard for the too the stone proved perform litholapaxy, lithotrite, and the instrument gave way. I determined, as the patient was young, to remove the stone immediately by the lateral operation. This I did, and the patient left the hospital well in fourteen days. I have cut seven times for stone successfuly?once by the median, five times by the lateral, and once by the supra-pubic method. With regard to the lateral, it is becoming the practice to depreciate this time-honoured and successful operation, and to put in its place for all cases the supra-pubic operation. This, I think, is a swing of the pendulum too far in the direction ; for whilst I believe that the lateral is the best for children, with regard to adults the case is
opposite
different, and here the
performed
;
supra-pubic operation
and I have
no
I
cases, to be the safest.
antiseptics, bladder.
and does
I should
doubt it will prove, in these Sir H. Thompson discards
see
up the wound in the to perform the operation under
not
prefer
should be
sew
antiseptic precautions, accurately suture the wound the bladder, and drain the bladder antiseptically; this
strict in
latter I found the most difficult part of the treatment, as blood-clots and mucus are very liable to frequently block the
opening
change thought
in the
catheter,
of the instrument.
thus
By
these difficulties may be
necessitating frequent
constant care and foreovercome.
OF VESICAL CALCULI.
Pickering, F.R.C.S., Surgeon
By
Charles F.
to the Bristol General
Hospital. Case 1.
18
J. M.,
months, aged hospital, suffering
a
very badly-nourished and puny child, admitted on May 26th into the
was
from acute retention of urine.
The
mother's account was, that it had never been strong, had suffered from no trouble with the water before, and never
passed blood nor complained of pain in micturition. Four days before admission she noticed the child seemed in great pain, and took it to a doctor, who said it had
had
stoppage
of the bowels.
The child continued to get
worse, and for the last two days had not passed any water. On admission, the bladder was found distended
A catheter was passed, and six up to the umbilicus. of water drawn off, which was of foul odour and
ounces
deposited one-third pus (?) on standing. The housesurgeon passed a sound, and thought he felt a stone once, but not again. I saw the child next day; but found it so ill, that I did not care to sound again. Morning temperature, 1020. On the following day, when I next saw the child, it was in articulo mortis. I examined with a sound, without chloroform, but could not detect any stone. The
184
VESICAL
child died risen
a
CALCULI.
few hours afterwards.
continuously
death, and the child had passed The
catheter.
only sign
retention of urine. at
no
no water
of stone in this
I did not examine
by
except by the case
was
the
the rectum,
as
time whilst in the
hospital did the condition of the cutting operation. The death was probacondition which is called, for want of a better
child allow of
bly
The temperature had
since admission to the time of
ever
due to
name,
"
a
a
urethral fever."
Post-mortem Examination.?The and
what
and the
kidneys pelvis of
were
some-
each kidney swollen, enlarged good deal dilated ; in other respects these organs were apparently healthy. The bladder was slightly inflamed, and contained, lying free in its cavity, a curious specimen of vesical calculus, about the size of a bantam's egg, and a
of
a
kind that I have not
The
specimen was one envelope.
thick fibrinous
seen
of
a
described before. hard
and measured two inches in its inch in its shortest. the size of
calculus, enclosed in a weighed 3J drachms, long diameter and one
The whole
The hard stone in the centre
pea, and
was
of uric acid.
The composed envelope was built up in layers of membrane, easily separated from each other, and forming a tough a
was
fibrinous
and compact shell.
occasionally
seen
Fibrinous calculi in the bladder but this
;
different
pathological origin
general,
which
appears to in this
me
case
the
bladder, mucus,"
blood
are
think,
a
calculi
in
clots.
It
that the formation of the thick membrane
is best
entrance
which
fibrinous
usually changed
are
formation: that on
specimen has, from
I
explained by
a
calculus-forming
of
gives
the German view of stone
a
stone or
rise to the
catarrh
is set
foreign body production of
"
up into the
fibrinous
and this forms the adhesive material which binds
VESICAL
CALCULI.
185
together the inorganic salts. In this specimen the adhesive material was deposited, but the salts are absent in the outer layers, and thus prevented the stone being felt by the sound. Case II. A young man, aged 16, was admitted into the hospital, complaining of incontinence of urine. On examination I found a very hard calculus, which I thought This proved to be the was oxalic acid in composition. I proceeded to after a few as admission, when, case, days hard for the too the stone proved perform litholapaxy, lithotrite, and the instrument gave way. I determined, as the patient was young, to remove the stone immediately by the lateral operation. This I did, and the patient left the hospital well in fourteen days. I have cut seven times for stone successfuly?once by the median, five times by the lateral, and once by the supra-pubic method. With regard to the lateral, it is becoming the practice to depreciate this time-honoured and successful operation, and to put in its place for all cases the supra-pubic operation. This, I think, is a swing of the pendulum too far in the direction ; for whilst I believe that the lateral is the best for children, with regard to adults the case is
opposite
different, and here the
performed
;
supra-pubic operation
and I have
no
I
cases, to be the safest.
antiseptics, bladder.
and does
I should
doubt it will prove, in these Sir H. Thompson discards
see
up the wound in the to perform the operation under
not
prefer
should be
sew
antiseptic precautions, accurately suture the wound the bladder, and drain the bladder antiseptically; this
strict in
latter I found the most difficult part of the treatment, as blood-clots and mucus are very liable to frequently block the
opening
change thought
in the
catheter,
of the instrument.
thus
By
these difficulties may be
necessitating frequent
constant care and foreovercome.
