On the comparative advantages of lithotomy and lithotrity : and on the circumstances under which one method should be preferred to the other / being the dissertation for which the Jacksonian Prize for 1838 was awarded to Edwin Lee.

  • Lee, Edwin, -1870.
Date:
[1842]
Catalogue details

Licence: Public Domain Mark

Credit: On the comparative advantages of lithotomy and lithotrity : and on the circumstances under which one method should be preferred to the other / being the dissertation for which the Jacksonian Prize for 1838 was awarded to Edwin Lee. Source: Wellcome Collection.

    18/68 (page 16)
    One chief cause of increased difficulty in performing the lateral operation consists in the greater thickness of the soft parts to be divided between the shin and the bladder, de¬ pending upon the quantity of adipose matter; upon muscu¬ lar and prostatic development, or a thickened state of the coats of the bladder. The depth of the perineum from one or a combination of these causes, is often so great as to prevent the operator's finger reaching the bladder, thus depriving him of the great advantage he obtains from the sense of touch when ope¬ rating upon subjects under puberty, in consequence of which se¬ veral lamentable instances are recorded of the bladder not having been opened, the cutting instrument having passed between it and the rectum, either in consequence of its slipping from the groove of the staff, or where this instrument has not been properly intro¬ duced into the bladder, but has rested on the prostate ; this part and the neck of the bladder being thus only partially divided, and the gorget or knife having been pushed on, lias entered the sub¬ jacent cellular texture, without penetrating into the bladder itself; or if an aperture has been made in this viscus, it has been too small to admit the blunt gorget or forceps, without the parts being lacerated and contused in the attempts. Hence arises in these cases the advantage of instruments which divide the neck of the bladder and prostate from within outwards, as the histourie cache. But even when a proper incision has been made into the blad¬ der, the thickness of the perineum renders the seizure and ex¬ traction of the stone much more difficult, especially if there coexist induration and enlargement of the prostate gland, from behind which the stone cannot sometimes be dislodged ; or if it be taken up by the forceps, and be not of small size, it frequently cannot be extracted without considerable effort, from the unyielding na¬ ture of the parts, thus risking laceration or contusion. Again, supposing the operation to have been performed, and the stone extracted without much difficulty, yet the depth of the perineum may be a cause of failure, in consequence of the great extent of surface of the wound exposed to the contact of the urine, produ¬ cing, in some instances, extensive suppuration and sloughing of the cellular texture, which would be most likely to terminate fatally; especially if the patient had been previously in a bad state of health. Another source of difficulty and danger, is where the stone is of large size, or if of moderate size, where the incision in the bladder is too small to admit of its extraction without the em¬ ployment of force. From the employment of an undue degree of force in extracting the stone, there is more danger to be appre¬ hended, than from any other cause, as when the parts are much injured in the attempts at extraction, the patient rarely survives.