On rest and pain : a course of lectures on the influence of mechanical and physiological rest in the treatment of accidents and surgical diseases, and the diagnostic value of pain / Ed. by W.H.A. Jacobson.

  • Hilton, John, 1804-1878.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: On rest and pain : a course of lectures on the influence of mechanical and physiological rest in the treatment of accidents and surgical diseases, and the diagnostic value of pain / Ed. by W.H.A. Jacobson. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

    82/526 (page 64)
    there, as far as I know; I am quite well.* Stone, then, is a disease requiring operation, because it induces a de- rangement of the structure which produces certain painful symptoms, and by removing the cause the part gets well —first, through the assistance of the surgeon, but ulti- mately through the medium of Nature. * The behavior of the bladder towards a stone in it is most peculiar and puzzling. In one case it displays almost perfect indifference, and even acts the part of host with an approach to hospitalit}', and allows the guest to grow and stay until it reaches enormous proportions. Some years ago I made a post-mortem examination on an old man dead of abdominal aortic aneurism, and discovered accidentally that the blad- der contained a large lithic stone which weighed nearly nine ounces. The bladder was healthy and the mucous membrane pale. For years I had occasionally attended this patient, but so little did this large stone trouble him, that neither he nor I were aware of its presence. In other cases, no sooner does a stone enter at one portal than the conflict be- gins, and goes on until either it is turned out along the urethral passage at the other portal, or the bladder is perpetually fretted, worried and inflamed, until either the surgeon or death comes to end the dispute. (Cadge on Lithotrity at one sitting. Lancet, Ap. 5, 1879.) Mr. H. Fenwick, in a paper on Latent Vesical Calculus, read before the W. Lond. Med. Chr. Soc. (Brit. Med. Journ., May 23, 1885,) pointed out that stone in the bladder was frequently overlooked, because calculus symp- toms were absent owing to (1) anaesthesia of the mucous membrane of the bladder, well exemplified in a case mentioned in Deschamp's Traite de la Traille, Vol. i. p. 106; or (2) mechanical causes preventing the stone from falling upon the sensitive neck of the bladder. These were of three kinds: (1) adherence of the calculus to the walls of the bladder; (2) sacculation of the bladder-walls; and (3) pouching of the bas fond of the bladder. He drew attention particularly to this last cause,,which was generally supposed to be a condition inherent to old age, as a con- sequence of enlarged prostate, but which was produced by stricture of the urethra. It consisted in the hypertrophy of the muscles of the urethra, common^ known as the muscles of Ellis, which crossed the base of the trigone from ureter to ureter; the bas fond pouched behind this ridge or bar, and the small pool of stagnant urine which collected there, tended to produce or augment the size of a stone. This ridge was as able to prevent the stone from falling on the neck of the bladder, as was an enlarged third lobe of a prostate.—[Ed.]