On a mode of after-treatment in operations upon the urinary organs : with illustrative cases / by T.R. Jessop.

  • Jessop, Thomas Richard, 1837-1903.
Date:
1869
Catalogue details

Licence: Public Domain Mark

Credit: On a mode of after-treatment in operations upon the urinary organs : with illustrative cases / by T.R. Jessop. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    To f>elvic cellulitis from urinary infiltration, to peritonitis, derived by extension of inflammation from the prostate made to suppurate by the flow of urine over its cut, torn, or crushed surface, to pytemia, in- duced by the absorption of pus from the recently made urinary fistula, tlie lithotomist will attribute a large proportion of his mortality. On two occasions, at least, I have found the pelvic cellular tissue in a state f)f suppuration, and more frequently I have known peritonitis to have been present on post mortem examination in cases which had undergone perineal section; occurrences which had undoubtedly been caused, either directly or indirectly, by the poisonous influence of the urtne. It is entirely due, moreover, to the frequent escape of through the wound, that troublesome fistulous openings every now and again remain, after the urethra has been laid open. It was in the endeavour to prevent this untoward occurrence in a youth, who had previously shown a pe- culiar tendency to the formation of fistula, that I first adopted the plan, which it is my object in this communication to advocate. In speaking of the treatment of urinary fistula. Sir Henry Thompson, in his Sixth Lecture, published in the Lancet, April 4th of last year, says: “It was sometimes attempted to cure such fistula by tying in a gum catheter for weeks or even for months; but this always fails, and for this reason, that urine always finds its way from the bladder by the side of the catheter, along the urethra, and so into the fistula, by the force of capillary attraction, and thus the object sup- posed to be attainable, in reality never was and never could be so ac- complished. The practical surgeon soon discovers that tying in an in- strument never ensures the transit of all the urine through it; some will always pass by the side and defeat your purpose. The experience of most surgeons, I imagine, will correspond with that of Sir Henry Thompson in showing that, when a catheter is fixed in the bladder, urine does make its way by the side of the instrument; but whether this escape of urine is brought about by the force of capil- lary attraction may fairly be questioned. Were that so, surely there woqld be an incessant dropping of urine upon the bed, rather than the occasional involuntary gush, and the voluntary stream through the in- strument on the withdrawal of the plug, or the turning of the stop- cock ; we should expect the bladder to be kept for the most part in an almost empty condition by constant dribbling, rather that to find, as I have many times found, that there are several ounces of urine to be let off at each visit. That the sphincter at the outlet of the bladder is less iwwcrful to retain urine when grasping a catheter, than when free to completely close the orifice it guards, the involuntary escape of the