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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    then daily passed for seven weeks, and afterwards twice a week during the few weeks he continued to attend at the hospital. When Ixst seen there was still a small opening through which urine flowed in drops. In October, he presented himself again, in a condition very similar to that in which he had been admitted in the previous J une, and again the operation was repeated, a No. 8 catheter being retained for nine days, and subsequently passed twice a week until he once more ceased to attend. Nothing further was seen of him until May 1864, when he applied at the hospital for an urinal to relieve him from the annoyance of incontinence. lie refused further treatment, although his urine was passed involuntarily for the most part through a small fistulous opening immediately behind the scrotum. When he applied to me in Novem- ber 1866, the perinaeum was wholly occupied by a laige abscess, and there was a constant dropping of urine from the end of the urethra. He had discarded his urinal, and consequently the skin of the penis, scrotum, and insides of the thighs, as low down as the knees, was in an almost raw condition. I opened the abscess by a deep central in- cision, and in a few hours urine flowed freely through the wound. When the swelling had subsided, and healing had proceeded apparently to its full extent, three-fourths of the urine was passed through the fis- tulous opening in the perinaeum, and the remainder dribbled from the end of the penis. I was unable to introduce any instrument into the bladder, even after the most persevering endeavours, and with the aid of chloroform. I therefore performed perineal section on January 29th, 1867, and fixed a No. 10 silver catheter in the bladdder. The end of the catheter was closed by a plug, which was directed to be withdrawn whenever urine was passed. At each passing of urine some escaped by the wound, so that, at the end of three weeks, the edges of the now contracted wound had assumed a healed appearance, and it was evident that a permanent fistula was about to be formed. On February 20th, with the intention of preventing the accumulation of urine by the pro- vision of a permanent drain, thereby securing a continued quiescent state of the bladder, and in the hope that the flow through the fistula would be wholly prevented, I attached an India-rubber tube, of the calibre of the catheter and two yards long, to the end of the catheter, and carried the unattached end into a vessel beneath the bed. The object was fully attained. Not a drop of urine was ever afterwards pa.ssed through the perinmum, and in little more than four weeks the wound had quite closed. For six months I occasionally passed a No. 10 bougie. lie remains well at the present time. Cask II.—In May 1867, William C., aged 6 years, was brought to