A case of urinary calculus, attended with peculiar circumstances, and treated by lithotrity / by L.A. Dugas.

  • Dugas, L. A. (Louis Alexander), 1806-1884.
Date:
[1851]
Catalogue details

Licence: Public Domain Mark

Credit: A case of urinary calculus, attended with peculiar circumstances, and treated by lithotrity / by L.A. Dugas. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    SOUTHERN MEDICAL AND SURGICAL JOURNAL, (EXTRA.) A Case of Urinary Calculus, attended with peculiar circumstances and treated by Lithotrity. By L. A. Dugas, M. D., Prof, of Surgery in the Medical College of Georgia, and Editor of the Southern Medical and Surgical Journal. The following case is reported because of certain peculiar features presented during its progress. The patient, Mr. John L. B., of Hall county, Ga., is 30 .years of age, was kindly directed to my care by Dr. Richard Banks, the distinguished surgeon of Gainesville, and arrived here on the 5th of February last. Having suffered from early childhood with phymosis and an almost complete closure of the orifice of the prepuce, (which he believes was congenital,) the difficulty of voiding his urine caused this to distend the prepuce into a considerable bag, to accumulate enormously in the bladder, to stagnate in the pelvis of the kidneys, and to induce very great impairment of the general health. The preputial orifice was so small as not to admit, without much difficulty, the introduction of a knitting needle; the urine was therefore never passed offin a jet, but the patient was subjected to all the inconvenience of a continual stillicidium; he had frequent and violent attacks of nephritic pains, attended with protracted chills, fevers, and the usual concomitants of retention of urine. Yet it was not until the 20th year of his age that he sought professional aid and was cir- cumcised by Dr. Banks. From that time his health improved rapidly ; but he continued subject to occasional paroxysms of severe nephritic pains, which now became confined to the left side. These pains would extend down along the course of the ureter and continue one or more days, leaving him in a debilitated state, from which he would, however, soon recover. He is not aware of ever having passed gravel or any- thing like calculous matter, although his urine would sometimes present a very copious sediment. This state of things continued until the middle of April last, when, although in good health and not having had any nephritic pain for about three months, he felt a calculus drop into his bladder. Atten- ding to his usual avocations, he stepped out to urinate, did so without any difficulty whatever, and when in the act of buttoning up his gar- ment, distinctly felt something fall into the bladder. He immediately mentioned the fact to a friend, and added that it must be a stone, for its fall produced a sensation like that of a buck-shot allowed to drop into a bag. A Cew hours afterwards, on again attempting to urinate, the stream was suddenly arrested by the engagement of the calculus in the urethra—the sensation being so distinct that he instinctively carried his hand to the perineum in order to force it out—but in vain ; and the same difficulty has ever since attended his micturition. These details are given as establishing conclusively the facts that he did know the precise moment at which the stone came into the bladder, and that this occurred so late as about three months after the last nephritic attack. He has experienced no pain whatever about the