Calculus in the Bladder, Cured by Lithotomy.

Abstract

Henry Gray, a fine healthy-looking boy, five years of age, had, according to the statement of his parents, been labouring under symptoms indicative of stone in the bladder for more than two years, during which time he had been taken to two surgeons, and twice sounded, without the cause of his sufferings being ascertained. I could not account for his symptoms in any other way than by supposing a stone to exist in the bladder, although it had before eluded detection. I accordingly introduced a sound, but after a careful examination, also failed in ascertaining the presence of a stone, or any disease of the bladder which could give rise to his symptoms. Warmbaths, opiates, and alkalies, were prescribed, under which plan of treatment his sufferings were so much alleviated, that I saw but little of him for about three weeks, when al1 his former symptoms had returned with increased severity, accompanied with a distressing irritability of the rectum. The sound being again passed unsatisfactorily, I ordered him opium in the form of suppositories, and increased the dose of his medicines ; this plan was persevered in for a week, without however affording that relief which he before experienced ; and his symptoms continuing very unequivocal, I again introduced the sound, when the presence of a calculus was clearly and readily ascertained.After a few days, on the 25th of October, in the presence of several friends, I performed the lateral operation. The urethra being laid open with the usual incisions, the gorget was applied and carried onwards; a gush of urine escaping at the time, satisfied me of its having entered the bladder ; the forceps were then introduced, and after using what I considered to be only the requisite force to overcome the usual resistance of the prostate, without their being, apparently, in the bladder, as their blades seemed grasped, and the stone could not be felt, I withdrew them, as well as the gorget, and° passing my finger into the wound, found that the opening was not large enough to admit of their entrance, and the force that had been applied had pushed them into the soft parts at the side of the bladder. On re-introducing the staff, some difficulty was experienced in consequence of its point entering the passage formed by the forceps, but after enlarging the opening into the bladder, a mulberry calculus of the size of a small nutmeg was easily extracted.An attack of peritoneal inflammation came on the second day after the operation, which required the most active treatment to sax-e the life of my little patient. Leeches and fomentations were freely applied, calomel was given in doses of 3 grains every three hours, the hypogastric region covered with a blister, and the vesicated surface dressed twice a day with mercurial oint. ment. In the course of a few days, under this treatment, all danger disappeared; and up to the date of writing this account (Nov. 28) he is in every respect doing well, although he has not yet quite regained his strength or colour. REFI.ECTIOXS.The above case shows the...