EXTRACTION OF
A VESICAL CALCULUS
IN A FEMALE. By Assistant-Surgeon Hardial
Singh, l.m.s., Hospital, Gujrat. Mussamut Bcjggi, a Mahomedan female, aged about 30 years, was admitted in the Gujrat Civil Hospital, on 14th March 1897, suffering from symptoms of stone in the bladder. She could feel the stone in the urethra herself, and also knew of its existence in the bladder by the passage of gravel during the last four months. She stated that, about a year ago, she began to pass pus with the urine, and felt difficulty iu micturition, which gradually increased. Being under the impression she was suffering from gonorrhoea, she put herself under the treatment of quacks without benefit. When she began to pass bits of stone with the urine, she believed that it was stone in the bladder that she was troubled with. On admission, the patient was found in a very weak, anaemic and emaciated condition; she was evidently suffering much from continuous pain. There was a foul-smelling discharge from the urethra, and the urine was passed in drops. The stone could be felt in the urethra and bladder with the sound and finger. The stone was found immediately within the meatus, which was of natural size. By examining per vaginam, the stone was easily felt as large as a big walnut compressed from before back, occupying the lower part of the bladder and distending the urethra into a sac. The external genitals were washed with carbolic lotion. Enema well was given ; patient was put under chloroform ; and operation for removal of stone performed by the Civil Surgeon, Surgeon-Major J. R. Adie, i.M.S., assisted by Female Hospital Assistant Jumna Devi. An attempt was made to inject a saturated boracic acid lotion, but very little reached the bladder. An instrument then dilated the urethra to admit the tip of the little finger. It was found impossible to introduce a lithotrite, as the stone tightly distended the urethral walls. During examination, fragments of stinking stone came away, and the calculus itself was crumbling in the centre so as to present a concavity to the finger. The meatus of the urethra was then deliberately cut with scissors up and down, enough to admit the forefinger and a pair of necrosis forceps or scoop. Then the stone was gradually brought away piecemeal. The bladder was carefully sounded and found to be contracted. The urethra was distended and merged into the small bladder behind, and ended simply in a meatus in front. One suture above and two below closed up the incisions in the urethra. The bladder The stone weighed 457 grains, was washed out. and consisted of calcium phosphate, as tested by Civil
June 1898.]
DRY GANGRENE.
the Professor of Chemistry, Lahore Medical ColOn the same evening patient had a rigor and temp. 103?. After-treatment.?The course of the case was uneventful. She could not retain urine during the first but control over the bladder
lege.
was
fortnight; gradually and completely regained.
The points of interest are : (1) The distension of urethra into a sac which merged into bladder behind and ended in the meatus in front. (2) The stone occupying this sac. (3) Its removal by ditffifinoj chiefly. It was not possible to say where bladder ended and urethra began. Probably the stone, originally vesical, was pushed downwards by the contracting bladder, and distended the urethra by its growth. Dr. Keegan relates a similar ease in Lancet,
January
9, 1897.
/
219
A VESICAL CALCULUS
IN A FEMALE. By Assistant-Surgeon Hardial
Singh, l.m.s., Hospital, Gujrat. Mussamut Bcjggi, a Mahomedan female, aged about 30 years, was admitted in the Gujrat Civil Hospital, on 14th March 1897, suffering from symptoms of stone in the bladder. She could feel the stone in the urethra herself, and also knew of its existence in the bladder by the passage of gravel during the last four months. She stated that, about a year ago, she began to pass pus with the urine, and felt difficulty iu micturition, which gradually increased. Being under the impression she was suffering from gonorrhoea, she put herself under the treatment of quacks without benefit. When she began to pass bits of stone with the urine, she believed that it was stone in the bladder that she was troubled with. On admission, the patient was found in a very weak, anaemic and emaciated condition; she was evidently suffering much from continuous pain. There was a foul-smelling discharge from the urethra, and the urine was passed in drops. The stone could be felt in the urethra and bladder with the sound and finger. The stone was found immediately within the meatus, which was of natural size. By examining per vaginam, the stone was easily felt as large as a big walnut compressed from before back, occupying the lower part of the bladder and distending the urethra into a sac. The external genitals were washed with carbolic lotion. Enema well was given ; patient was put under chloroform ; and operation for removal of stone performed by the Civil Surgeon, Surgeon-Major J. R. Adie, i.M.S., assisted by Female Hospital Assistant Jumna Devi. An attempt was made to inject a saturated boracic acid lotion, but very little reached the bladder. An instrument then dilated the urethra to admit the tip of the little finger. It was found impossible to introduce a lithotrite, as the stone tightly distended the urethral walls. During examination, fragments of stinking stone came away, and the calculus itself was crumbling in the centre so as to present a concavity to the finger. The meatus of the urethra was then deliberately cut with scissors up and down, enough to admit the forefinger and a pair of necrosis forceps or scoop. Then the stone was gradually brought away piecemeal. The bladder was carefully sounded and found to be contracted. The urethra was distended and merged into the small bladder behind, and ended simply in a meatus in front. One suture above and two below closed up the incisions in the urethra. The bladder The stone weighed 457 grains, was washed out. and consisted of calcium phosphate, as tested by Civil
June 1898.]
DRY GANGRENE.
the Professor of Chemistry, Lahore Medical ColOn the same evening patient had a rigor and temp. 103?. After-treatment.?The course of the case was uneventful. She could not retain urine during the first but control over the bladder
lege.
was
fortnight; gradually and completely regained.
The points of interest are : (1) The distension of urethra into a sac which merged into bladder behind and ended in the meatus in front. (2) The stone occupying this sac. (3) Its removal by ditffifinoj chiefly. It was not possible to say where bladder ended and urethra began. Probably the stone, originally vesical, was pushed downwards by the contracting bladder, and distended the urethra by its growth. Dr. Keegan relates a similar ease in Lancet,
January
9, 1897.
/
219
