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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    that whereas the ureters are comparatively passive in their resistance to dilating agents, the urethra is essentially different—and also that the column of urine emerging from the kidney would necessarily press forward a body situated in the ureter until it entered the blad- der, if possible; but that the calculus might remain in this reservoir without being necessarily forced into the urethra. Again: according to B. the urethra should have synchronised liberally in the dilatation of the ureters. This is a new doctrine, for the originality of which the critic is unquestionably entitled to credit. A. case in which the urethra would synchronise with the ureters in a dilatation consequent upon the descent of a renal calcu- lus would indeed be remarkable, extraordinary, and marvel- lous. Whether or not the urethra should synchronise liberally in the dilatation of the ureters occasioned by phimosis, is not the question before us, since in this case as reported, no phymosis had existed for more than nine years before the period at which the cal- culus is alledged to have passed into the bladder. 2d.—The statement of the patient that he heard something drop, and therefore knew the exact moment of the entrance of the calculus into the bladder, seems to have made a profound impression upon Professor Dugas, for he unhesitatingly gave credence to the statement. The patient may be excused for thinking that a calculus could fall from the ureter into the bladder, but we have some difficul- ties in our faith. The ureters enter the has fond of the bladder, very obliquely, and a stone would have to fall up in falling from the ureter into the bladder. And then when we remember the pathological truths of Mr. Aldridge, which seem to show that the oxalate of lime is not secreted in the kidneys, when we remember that there is no kind of evidence that the ureters in this case were dilated even in the slightest degree, and that the passage of a mulberry calculus through the ureter would have made a man feel a multitude of other things besides the falling of the calculus, we must remember that we have before us what may be called the difficulties of faith. I have no right to complain that B. has not as much faith in the statement of the patient as I have, who know him to be an honest and intelligent gentleman. If all the circumstances detailed in the second paragraph of my report are not deemed by B. sufficient to establish conclusively the facts that he did know the piecise moment at which the stone came into the bladder, the fault is not mine. I will not stop to correct an error of quotation, nor to return thanks for B.'s sapient anatomical and philosophical suggestions. I am still however, credulous enough to believe that a calculus may emerge from the ureter suddenly and with sufficient force to occasion just such a sensation as that of a buck-shot allowed to drop into a ba<r. I do not know any form of expression by which my patient could have imparted a more accurate idea of his sensation, and it is therefore I gave his own language.