A treatise on the formation, constituents, and extraction of the urinary calculus : being the essay for which the Jacksonian Prize for the year 1833 was awarded by the Royal College of Surgeons in London / by John Green Crosse.

Date:
1835
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the formation, constituents, and extraction of the urinary calculus : being the essay for which the Jacksonian Prize for the year 1833 was awarded by the Royal College of Surgeons in London / by John Green Crosse. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    The gum-elastic catheter, so greatly extolled and preferred by high authorities,4 will he found to give feeble evidence of a stone, such as I would not rely upon for undertaking an operation; I consider it suited to cases of enlarged prostate, or where you cannot readily get another instrument into the bladder; but never ought to be employed to the exclusion of the solid sound or the silver catheter, when cystotomy is to be decided upon. If the surgeon meditate to operate with a straight staff, he must introduce previ- ously a straight sound (plate xxviii, fig. 1;) but such an instrument can be expected only to detect a moveable stone resting at the neck, posterior part or fundus of the bladder, and is not suited for exploring the whole of the vesical cavity, nor capable of taking a great variety of movements. In every case, before undertaking an operation for the removal of a vesical cal- culus, the surgeon ought to examine with the finger in ano. In young patients, we can feel through the rectum the whole outline of the bladder, and often tell the size and situation of the stone contained in it. In the adult, examining by the rectum enables you to detect a calculus in the membranous or prostatic portion of the urethra, or acquaints you with the size and condition of the prostate gland; and when the finger is long enough, you can tell the state of the bladder, as to tenderness on pressure, and thickness of its coats. Not unfrequently you can feel the stone by the rectum, balance its weight upon the finger, or tell its shape, its surface and situation.5 A good deal of tact is however required to profit by this mode of examining; in a child during violent screaming and straining, the coats of the bladder contract so firmly on the contained urine, that it feels a tense body, shaped like a walnut; and no stone can be detected, till this state has subsided. In judging of the size of the stone, you must allow for the thickness of intervening 4 The late Sir E. Home, Bart, and Sir B. C. Brodie, Bart, have particularly recommended the gum- elastic catheter for sounding, introduced without the stilet, and have pointed out the advantages it possesses. In the Edinb. Surgical Journal, vol. xii, p. 295, a sound with a bulbous end is described by Mr. James Barlow, which is deserving of attention. 5 Rudtorffer observes that examining per rectum with the finger gives evidence, in respect to the stone, as to “ number, size, roughness and mobility.” (Abhandlung iiber die Operation des Blasensteines nach Pajolas Metliode, s. 61.)