A case of large secondary prostatic calculus, removed by perinæal incision / by T. Herbert Barker.

  • Barker, T. Herbert (Thomas Herbert), 1814-1865.
Date:
1847
Catalogue details

Licence: Public Domain Mark

Credit: A case of large secondary prostatic calculus, removed by perinæal incision / by T. Herbert Barker. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    All that could be learned of his previous histoiy was, that since he had been four years of age he had laboured under incontinence of urine, which had rendered him very oflFensive to society, and had long since induced him to abandon it as much as possible. Some years ago he had been a patient in the Infirmary, but without any relief. He had never suffered very severe pain, nor from retention of urine before the present attack, and urine had never flowed through any other than the natural channel before the formation of the fistulous opening four days before. He was directed to maintain the horizontal position, to use fomentations of warm water to the perinaeum, to di'ink as little as possible, and to take simple aperients. His mind was pre- pared for-the probable necessity of removing the calculi on the following day. October 26th, Eleven a.m.—Visited him with my pupil, found him in the same state in which he had been left on the preceding day, and again made a careful examination of the perinseum and per rectum, which ended in the thorough conviction of the presence in the posterior part of the urethra of several calculi of large size. Another attempt was made to pass the probe further backwards through the fistulous opening, but with the same result. OPERATION. Having procured the assistance of a strong man in the neigh- bourhood, to sit behind and hold my patient, he was placed in the position for lithotomy, and the calculi were removed in the following manner:—The perinseal integuments were rendered tense with the left fore-finger and thumb, and an incision made through them together with the superficial fascia, two or three lines to the left of the raphe, commencing about two inches and a-half from the anterior margin of the anus, and terminating within half an inch of this margin. On introducing the point of the finger into the incision, the calculus could be readily felt, and was cut down upon with the point of the bistoury, and the intervening soft parts were divided upwards and downwards to the entire extent of the first incision. Observing that the several portions of the calculus were firmly wedged together, and that it was impossible, from its size, to