A CASE
OF VESICAL
LATER AL LITHOTOMY
CALCULUS; :
By Mohendra Lall
RECOVERY.
Bose,
Assistant-S'i rgeon, Raneegunge. Grish aged 7 years. Hindoo, male, was admitted into
the Lla ueegnnge Charitable
Hospital
on
the 3rd October
14
THE INDIAN MEDICAL GAZETTE.
1875 with symptoms of stone in the bladder. His mother stated that he suffered from symptoms of vesical calculus for the last three years. There was difficult and painful micturition ; voiding urine in drops and frequently squeezing of the penis at the time of making water, and prolapse of the rectum. On enquiry she said that he never suffered from retention, nor passed any blood during the whole period of his illness. Present symptoms.?Appearance healthy ; frequency in passing urine attended with straining and pain ; prolapsus of the rectum, and an uneasy sensation in the glans penis; appetite good and bowels regular. Physical symptoms.?After admission I passed a metallic catheter into the bladder and heard a ringing sound, produced by contact of the stone with the end of the catheter. Atli.?A dose of castor oil was given this evening to clean out his bowels. 5th.?At about 8 a. m. this day he was put on the operating table, and Native Doctor Baboo Loke Nauth Ghosh, a private practitioner, administered chloroform to him. When he was fully under its influence, Native Doctor Kherode (Jhunder Gossamy, my assistant, passed a grooved staff into his bladder and held it in the position I desired him to do ; I then took a knife and made the necessary incisions to reach the bladder. When this part of the operation was done I introduced my left index finger into the bladder and felt the stone in it. After dilating the opening in the bladder with my finger, I took a pair of forceps and got it easily into it. As soon as the forceps was in the bladder, the stone was felt and caught. But unfortunately for the patient, and to my great anxiety, the stone broke into two pieces under the forceps; one of which, grasped by the forceps, The next came out, leaving the other in the bladder. attempt to reach the bladder was attended with danger to the patient; my finger, instead of going into it, slipped into the recto-vesical fossa. I immediatel}" perceived my mistake, and took the finger out. But again with care I passed it, and then a pair of forceps, by which the remaining portion of the stone was extracted. The wound was afterwards dressed with carbolic oil and the patient kept quiet. Fifteen minutes after operation a mixture containing tincture opii TH.X. and aqua 3iv. was given and fomentation ordered and continued 4 or 5 times. 5 P. M.?Complains of slight pain in the hypogastrium ; has got fever ; fomentation with turpentine continued, and fever mixture 3 iv. every third hour. 6th.?Severe pain in the abdomen, it has swollen and become tympanitic ; puise quick ; tongue dry and coated : is thirsty and restless ; had no sleep and stool ; wound looks healthy ; castor oil 3 iv. st. ; fomentation continued, and milk and sago for diet. 5 p.m.?No stool; in the same state ; castor oil 3iv. repeated. 9 p.m.?No stool ; sufferings aggravated ; calomel gr, ij. ordered. 1th October, 6 A. M.?Passed one large and thin stool just now ; in other respects much the same ; wound healthy ; Liqr. ammon. acetat. mixture with 3 drops of tinct, opii ordered every 4th hour ; fomentation and diet continued ; wound dressed with carbolic oil. 4 p. M,?Another thin stool just now ; a blister applied to the bladder. 8th.?Abdomen less tympanitic, but pain and other symptoms were much the same; passed several pieces of stone with the urine ; medicines and diet continued. 2 p. M.?State of the patient much the same ; calomel gr. ij. ordered. 8 p. M.?No stool ;tabdomen very painful; castor oil 3 iv. stat. 9th.?Had 3 stools last night after castor oil; pain much less ; abdomen neither swollen nor tympanitic; skin a little warm ; feels better ; tongue still unclean ; wound granulating ; Liqr. ammon. acetat. mixture continued without opium ; dressing and diet continued. 4 p. M.? Increase of fever; abdomen again tympanitic and painful ; castor-oil 3iv. ordered immediately.
[January 1,
1879.
10th.?Had two large serai-fluid stools last night after pain and tympanism less ; wound healthy and granulating ; mixture continued with mag. sulph. gr. x. every fourth hour ; milk and sago and soup for diet. 4 P. M.?No flatulency pain much less. Wih.?Abdomen has auain swollen a little and pain a little aggravated, no stool ; skin warm; castor-oil 3iv. 4 p. M.?Passed two stools. stat. and mixture continued. \2th?There was discharge of white pus through the wound with urine ; tympanism and pain less ; conjunctiva congested ; medicine and diet continued: alum lotion to the eyes. 4 p. M.?About an ounce of healthy pus discharged through the wound ; no stool ; pulse small and feeble. Liqr. amnion, acetat. mixture discontinued.
castor oil ;
Rl
?
,
Tinct cinchonas calunibaj
Aqua
... ...
...
TTlxx m XV 3iv
Mixture every 4th hour.
R/
Castor oil
...
3 stat.
13th.?Had two stools last night; passed about two of pus through the wound; no tympanism, pain slight ; no fever ; pulse a little improved ; medicine and diet continued. All the bad symptoms, i. e., tympanism and pain, gradually diminished and disappeared within 3 or 4 days, after the 13th of October ; but the discharge of pus through the wound continued, though diminished gradually, till the 11th of November. After that date there was no discharge of pus from the wound. His bowels were costive during the whole period of his illness, and castor oil was given regularly once in a day. A mixture containing rum, tincture of cinchona and tincture of calumba was prescribed on the 14th October, which he used After up to the day of his discharge from the hospital. the discharge of pus had stopped, he began to regain his flesh and health, and the wound gradually but completely healed. He was allowed to go home, cured, on the 25th November 1875. Remarks.?Lateral lithotomy in children is a very successful operation ; but if, in the second step of it, the left index linger of the operator or the forceps slips into the recto-vesical space, instead of going into the bladder,pelvic cellulitis or peritonitis is sure to occur, and the patient invariably dies unrelieved. During the last 7 years I have performed this operation in children 8 or 9times, and had the painful experience of two cases, which met with this accident within the above period. The first case?a strong and healthy boy of 6 or 7 years old?underwent operation at my hands in the Ganges Canal Hospital at Roorkeein the year 1873. From the day of operation he became very restless and began to suffer from the symptoms of peritonitis. On the second day the perineal wound assumed a very unhealthy character, and discharge of unhealthy sanious pus commenced to take place. These untoward symptoms gradually increased and continued till his death, which sad event occurred 10 or 11 days after the operation. Grish, the subject of this paper, was my second In him the accident would not have occurred, case. had not the stone, which was of a soft character, broken under the forceps. It is, however, satisfactory to find that although such a dangerous and distressing mishap happened to the lad, his health seriously broken down, and body was worn almost to a shadow from long suffering, gradually regained his health and flesh, and at last thoroughly recovered. There were two conditions which, I believe determined the results of these two patients ; they were the state of the perineal wound, and the character of the purulent discharge from it. In the first patient the perineal wound assumed a very unhealthy character from the second day ounces
January 1,
1879.]
A MIRROR OF HOSPITAL PRACTICE.
of tlie operation ; it became sloughy and at last gangrenous. The discharge was scanty and sanious, and had the putrid smell of gangrene. In the second patient the perineal wound maintained its healthy character from first to last; it began to granulate from the 5th day of operation, but remained open as long as the flow of pus continued, after which the wound was filled up by granulation and cicatrized. The discharge in, this case was copious, and continued for nearly a month, and the pus from the beginning was thick and white. Similar cases of accident, as described by Dr. Erichsen, are always fatal. But I am led to believe from the result of my second patient that if the perineal wound and the discharge from it remain healthy, the patient may rally and recover.
Raneegunge,
lsi
September 1878y
j.5
OF VESICAL
LATER AL LITHOTOMY
CALCULUS; :
By Mohendra Lall
RECOVERY.
Bose,
Assistant-S'i rgeon, Raneegunge. Grish aged 7 years. Hindoo, male, was admitted into
the Lla ueegnnge Charitable
Hospital
on
the 3rd October
14
THE INDIAN MEDICAL GAZETTE.
1875 with symptoms of stone in the bladder. His mother stated that he suffered from symptoms of vesical calculus for the last three years. There was difficult and painful micturition ; voiding urine in drops and frequently squeezing of the penis at the time of making water, and prolapse of the rectum. On enquiry she said that he never suffered from retention, nor passed any blood during the whole period of his illness. Present symptoms.?Appearance healthy ; frequency in passing urine attended with straining and pain ; prolapsus of the rectum, and an uneasy sensation in the glans penis; appetite good and bowels regular. Physical symptoms.?After admission I passed a metallic catheter into the bladder and heard a ringing sound, produced by contact of the stone with the end of the catheter. Atli.?A dose of castor oil was given this evening to clean out his bowels. 5th.?At about 8 a. m. this day he was put on the operating table, and Native Doctor Baboo Loke Nauth Ghosh, a private practitioner, administered chloroform to him. When he was fully under its influence, Native Doctor Kherode (Jhunder Gossamy, my assistant, passed a grooved staff into his bladder and held it in the position I desired him to do ; I then took a knife and made the necessary incisions to reach the bladder. When this part of the operation was done I introduced my left index finger into the bladder and felt the stone in it. After dilating the opening in the bladder with my finger, I took a pair of forceps and got it easily into it. As soon as the forceps was in the bladder, the stone was felt and caught. But unfortunately for the patient, and to my great anxiety, the stone broke into two pieces under the forceps; one of which, grasped by the forceps, The next came out, leaving the other in the bladder. attempt to reach the bladder was attended with danger to the patient; my finger, instead of going into it, slipped into the recto-vesical fossa. I immediatel}" perceived my mistake, and took the finger out. But again with care I passed it, and then a pair of forceps, by which the remaining portion of the stone was extracted. The wound was afterwards dressed with carbolic oil and the patient kept quiet. Fifteen minutes after operation a mixture containing tincture opii TH.X. and aqua 3iv. was given and fomentation ordered and continued 4 or 5 times. 5 P. M.?Complains of slight pain in the hypogastrium ; has got fever ; fomentation with turpentine continued, and fever mixture 3 iv. every third hour. 6th.?Severe pain in the abdomen, it has swollen and become tympanitic ; puise quick ; tongue dry and coated : is thirsty and restless ; had no sleep and stool ; wound looks healthy ; castor oil 3 iv. st. ; fomentation continued, and milk and sago for diet. 5 p.m.?No stool; in the same state ; castor oil 3iv. repeated. 9 p.m.?No stool ; sufferings aggravated ; calomel gr, ij. ordered. 1th October, 6 A. M.?Passed one large and thin stool just now ; in other respects much the same ; wound healthy ; Liqr. ammon. acetat. mixture with 3 drops of tinct, opii ordered every 4th hour ; fomentation and diet continued ; wound dressed with carbolic oil. 4 p. M,?Another thin stool just now ; a blister applied to the bladder. 8th.?Abdomen less tympanitic, but pain and other symptoms were much the same; passed several pieces of stone with the urine ; medicines and diet continued. 2 p. M.?State of the patient much the same ; calomel gr. ij. ordered. 8 p. M.?No stool ;tabdomen very painful; castor oil 3 iv. stat. 9th.?Had 3 stools last night after castor oil; pain much less ; abdomen neither swollen nor tympanitic; skin a little warm ; feels better ; tongue still unclean ; wound granulating ; Liqr. ammon. acetat. mixture continued without opium ; dressing and diet continued. 4 p. M.? Increase of fever; abdomen again tympanitic and painful ; castor-oil 3iv. ordered immediately.
[January 1,
1879.
10th.?Had two large serai-fluid stools last night after pain and tympanism less ; wound healthy and granulating ; mixture continued with mag. sulph. gr. x. every fourth hour ; milk and sago and soup for diet. 4 P. M.?No flatulency pain much less. Wih.?Abdomen has auain swollen a little and pain a little aggravated, no stool ; skin warm; castor-oil 3iv. 4 p. M.?Passed two stools. stat. and mixture continued. \2th?There was discharge of white pus through the wound with urine ; tympanism and pain less ; conjunctiva congested ; medicine and diet continued: alum lotion to the eyes. 4 p. M.?About an ounce of healthy pus discharged through the wound ; no stool ; pulse small and feeble. Liqr. amnion, acetat. mixture discontinued.
castor oil ;
Rl
?
,
Tinct cinchonas calunibaj
Aqua
... ...
...
TTlxx m XV 3iv
Mixture every 4th hour.
R/
Castor oil
...
3 stat.
13th.?Had two stools last night; passed about two of pus through the wound; no tympanism, pain slight ; no fever ; pulse a little improved ; medicine and diet continued. All the bad symptoms, i. e., tympanism and pain, gradually diminished and disappeared within 3 or 4 days, after the 13th of October ; but the discharge of pus through the wound continued, though diminished gradually, till the 11th of November. After that date there was no discharge of pus from the wound. His bowels were costive during the whole period of his illness, and castor oil was given regularly once in a day. A mixture containing rum, tincture of cinchona and tincture of calumba was prescribed on the 14th October, which he used After up to the day of his discharge from the hospital. the discharge of pus had stopped, he began to regain his flesh and health, and the wound gradually but completely healed. He was allowed to go home, cured, on the 25th November 1875. Remarks.?Lateral lithotomy in children is a very successful operation ; but if, in the second step of it, the left index linger of the operator or the forceps slips into the recto-vesical space, instead of going into the bladder,pelvic cellulitis or peritonitis is sure to occur, and the patient invariably dies unrelieved. During the last 7 years I have performed this operation in children 8 or 9times, and had the painful experience of two cases, which met with this accident within the above period. The first case?a strong and healthy boy of 6 or 7 years old?underwent operation at my hands in the Ganges Canal Hospital at Roorkeein the year 1873. From the day of operation he became very restless and began to suffer from the symptoms of peritonitis. On the second day the perineal wound assumed a very unhealthy character, and discharge of unhealthy sanious pus commenced to take place. These untoward symptoms gradually increased and continued till his death, which sad event occurred 10 or 11 days after the operation. Grish, the subject of this paper, was my second In him the accident would not have occurred, case. had not the stone, which was of a soft character, broken under the forceps. It is, however, satisfactory to find that although such a dangerous and distressing mishap happened to the lad, his health seriously broken down, and body was worn almost to a shadow from long suffering, gradually regained his health and flesh, and at last thoroughly recovered. There were two conditions which, I believe determined the results of these two patients ; they were the state of the perineal wound, and the character of the purulent discharge from it. In the first patient the perineal wound assumed a very unhealthy character from the second day ounces
January 1,
1879.]
A MIRROR OF HOSPITAL PRACTICE.
of tlie operation ; it became sloughy and at last gangrenous. The discharge was scanty and sanious, and had the putrid smell of gangrene. In the second patient the perineal wound maintained its healthy character from first to last; it began to granulate from the 5th day of operation, but remained open as long as the flow of pus continued, after which the wound was filled up by granulation and cicatrized. The discharge in, this case was copious, and continued for nearly a month, and the pus from the beginning was thick and white. Similar cases of accident, as described by Dr. Erichsen, are always fatal. But I am led to believe from the result of my second patient that if the perineal wound and the discharge from it remain healthy, the patient may rally and recover.
Raneegunge,
lsi
September 1878y
j.5
