Two lectures on lithotrity and the bi-lateral operation : delivered in London, Birmingham, Bath, and Bristol / by Edwin Lee ; from the London medical gazette.
- Lee, Edwin, -1870.
- Date:
- 1837
Licence: Public Domain Mark
Credit: Two lectures on lithotrity and the bi-lateral operation : delivered in London, Birmingham, Bath, and Bristol / by Edwin Lee ; from the London medical gazette. Source: Wellcome Collection.
Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.
13/18 (page 13)
![]3 much more common than in females. Li- thotomy in women, though not attended with the same difficulties and dangers as in men, is so frequently productive of con- sequences which tend to embitter the re- mainder of life, that the invention of litho- trity, by which, from the more simple anatomical structure of the female parts, lithotomy will probably be altogether su- perseded iu women, must on their account alone, and exclusive of the advantage it is calculated to confer on male patients, be considered as a circumstance of the highest importance. Several of the objections that have been made to lithotrity, and especially to the method by perforation, will not, of course, apply to cases of stone in females, in whom the introduction and action of straight instruments are attended with no difficulty. The size and composition of the stone, and, if there be more than one, the number of them, are important circumstances to be considered, in guiding the judgment of the surgeon as to the applicability of litho- trity or lithotomy to particular cases. The calculi most frequently met with in the bladder are composed of uric acid, or urate of ammonia, of phosphate of lime, of the ammoniaco-magnesian phosphate, and of oxalate of lime; but they are very often of a mixed composition, such as a nucleus of urate of ammonia, or of oxalate of lime, and a covering of the phosphates; or are composed of layers of phosphate and of urate of ammonia. The composi- tion of stones may often be guessed by sounding and the examination of the urine, and is of great importance as re- gards lithotrity, in determining their size, density, or friability. If it were ascer- tained that a calculus was of the phosplia- tic variety, it would be knowm that no difficulty would be experienced in break- ing it down; and lithotrity would be con- sidered the most suitable method of re- moving it, should its employment not be counterindicated by other circumstances. On the other hand, should the calculus consist of oxalate of lime, which cannot sometimes be broken, or is broken with great difficulty, the fragments of which would be likely to injure the bladder, and would require the employment of much force to reduce them to portions suffi- ciently small to pass through the urethra, lithotomy would be preferred, if circum- stances were favourable to its performance. The calculi, however, which are most fre- quently met with, are of various degrees of density between these two extremes. Many arc of moderate hardness, and may he broken without difficulty by pressure. Some are harder at particular points than at others, and require the combination of percussion with pressure to break them. Others, though hard, are brittle, and can- not easily be broken by pressure without great lorce, but yield readily on percussion. Some stones, again, are much harder than others which have a similar composition, which may depend upon the proportion of the animal matter which binds the earthy parts together, upon the length of time the disease has existed, and upon other circumstances. When, therefore, there is only one stone —when it is small, or of moderate size, and friable—when there exists no stricture or unusual curvature of the urethra—no en- largement of the prostate, or diseased state of the urinary organs—when the bladder is moderately capacious, and when the patient is not of a nervous and irritable disposition, the circumstances may be considered highly favourable for lithotrity; whereas, if the stone be of large size, or excessively hard—if there be several stones in the bladder—if the urethra be unusually narrow, strictured, or excessively curved— if there be enlargement of the prostate, a contracted or diseased state of the bladder, or if the patient be of a highly irritable disposition, the performance of lithotrity, if not altogether counterindicated, would be attended with more doubtful success. In those cases where, from loss of tone of the muscular coat, or complete paralysis of the bladder, the patient labours under chronic retention of urine, lithotrity would be performed under very unfavour- able circumstances, as the fragments could neither be expelled, nor could they pass away through the catheter on the urine being drawn o(T. In such a case Weiss’s scoop and catheter forceps would be of the greatest service, in enabling the ope- rator to get rid of the fragments. Chronic inflammation of the bladder, or catarrhus vesica;, as it is termed, though an unfavourable complication, and often aggravated, is sometimes diminished after two or three sittings of lithotrity, and even after the extraction of the foreign body by lithotomy. In this case lithotrity by pressure would be the most preferable operation, if not counter-indicated by other circumstances. In children, and young persons of the male sex below puberty, lithotomy is gene- rally preferable to lithotrity, which in these cases presents great inconveniences in consequence of the narrowness of the urethra. On this account the instruments are required to be of much slighter con- struction, and must necessarily be much weaker, while there would not be a pro- portionate friability of the calculus, which in young subjects is mostly of the uric acid or oxalate of lime varieties: hence the greater liability of fracture or displace-](https://iiif.wellcomecollection.org/image/b21438638_0015.jp2/full/800%2C/0/default.jpg)
