Observations based on the probable mode of formation of urinary stone relative to its recurrence and prevention / by Reginald Harrison.

  • Harrison, Reginald, 1837-1908.
Date:
1901
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Licence: In copyright

Credit: Observations based on the probable mode of formation of urinary stone relative to its recurrence and prevention / by Reginald Harrison. 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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    la an interesting paper relating to stone formation Dr. Lindley Scott has recently shown how oxalate of lime may be artificially resolved into other combinations and so be excluded in this form from the urine. Thus the formation of this kind of stone may be rendered inoperative. It is hardly necessary to say in connexion with the tendency to the formation of urinary gravel at d stone that morbid conditions of the excretion as indicated by an excess of normal constituents, or by the introduction of elements which are foreign to the urine, should as far as possible be dealt with on general principles which are sufficiently recognised and provided for. Excesses of urates and uric acid, for instance, as observed in the gouty, and the introduction into the urine of oxalates, cystin, and the like, are indications which will not be allowed to pass without special notice and attention. My contentions, however, are for the most part based upon proportions which may be normal, I will briefly refer to two points connected with the pro- cesses of removing stone from the bladder which have a bearing upon the subject of recurrence. In the first place every care should be taken, especially in the case of crushing operations, to remove all fragments of stone from the bladder. It should be remembered that the bladder of a man obstructed by an enlarged prostate in front of it, not uncommonly more closely resembles the section of a coarse bath sponge than the inside of a tea-cup. Thus the difficulties of clearing the former are considerably increased as compared with the latter. But the successful accomplishment of this is not often unattainable and should be first demonstrated to be so before crushing is put aside on this ground. In the second place, care should be exercised, whether lithotomy or lithotrity is selected, to avoid introducing rough scar-tissue into the bladder. It is just as liable to cause stone concretion as any other foreign body. I illustrated this in the Surgical Section at the meeting of the British Medical Association in 1900. One reason for the success and comparative rarity of stone recurrence noted in earlier days by lithotomists who practised median and lateral lithotomy correctly was that they introduced no scar-tissue afterwards within the area of the bladder. When I was engaged in teaching pathology and surgery I had several opportunities 15 Brit. Med. Jour., Oct. 13th, 1900.