On litholapaxy / by Robert F. Weir.

  • Weir, Robert F. (Robert Fulton), 1838-1927.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: On litholapaxy / by Robert F. Weir. 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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    as was desired. The weight of the fragments extracted was 486 grains. Both Thompson’s and Bigelow’s aspirators were used, also straight and curved evacuators, sizes 26 to 30. 'I he patient was in good condition the next day, and had at no time any unpleasant bladder symptoms. Polyuria to the amount of eighty ounces per diem was noticed for nearly three weeks after the operation. A fragment lodged in the urethra three inches from the meatus Oct. 31, and was, after trial of usual methods, removed by external incision. After that date an abscess appeared in the legion of the scrotum, which, when opened, gave exit first to pus, and subsequently to urine. On Nov. 11, on account of a fresh impaction in urethra, well l)ack, and of the continuance of the false passage, and of the abscess in perineo, the remainder of the calculus (65 grains, in one lai-ge (22 grains) and several small fragments) was removed by median lithotomy. The incision opened into the track of an abscess running up into the ischio-rectal tissues. The patient has since done well. In nearly all the cases, not my own, I acted either as an assistant to the surgeon in charge, or was a witness to the operation. The following sum- mary of experience is the result, offered, however, with some hesitation, as a larger observation may change the views set forth. The remarks to be made apply first to the instruments, and second to the operation itself. The Instruments.—The lithotrite of Bigelow I must speak of in all praise, both for its ease of working, on account of its ball-lfandle and mode of bringing the screw-power to bear, as well as for its general freedom from risk of pinching the mucous membrane, and from its facility of introduc- tion. I have, however, learned that Dr. Bigelow believes that it can be and needs to be improved, in this latter respect. In its introduction care is to be observed that, after entering the hole in the triangular ligament, the outer end of the instrument should not be too rapidly depressed between the patient’s thighs. A steady but gentle pressure downwards of the lithotrite, while at an angle of 45° with the horizon, relieves the roof of the prostatic urethra from the rubbing of the toe of the shoe, or jaws of the instrument. A tendency to impaction was noticed in two instances, but when the lithotrite was withdrawn it was ascertained to be due to the slot in the shoe or female blade not being in correspondence with the termination of the groove between the two shanks of the instrument. This defect has been remedied by enlarging the posterior part of the opening in the shoe. The size of those made by Weiss, after a pattern of Bigelow’s, is to my mind too large, save for exceptional cases. They measure 33 of the French scale, a size which in one case could not be passed through a normal urethra, and in another, by reason of the very slightest amount of impaction between the jaws, required considerable force to draw it through the spongy urethra. Of course, the lithotrite can be made of various sizes, as Bigelow plainly directs, and it is true that large instruments are better for crushing the largest stones. Certainly I should desire to use, in a calculus more than one inch in diameter, the largest instrument of Bigelow’s pattern I could safely pass through the urethra ; but I consider it always advisable that the lithotrite should be at least two.or three sizes smaller than the urethra, say, for