LITHOLAPAXY IN MALE CHILDREN.
May, 1887.]
cautious
MAY, 1887.
a
working
statement
long
LITHOLAPAXY IN MALE CHILDREN.
of
preliminary injection
Careful
?ln{ Jitdtsit JUijdiiial
149
as
are
of
course
"
this
urine in the
aspirator
Such
necessary.
the
operation lasted as two minutes, and the
three hours and
as
and
water
clear to theeud"?
was
The papers which appear in this number from the pens of Drs. Rate and Goldsmith con-
speaks volumes manipulation.
interesting sequel to the important which Surgeon-Major D.F. Keegan experience
years old, aud the stoue weighed 700 grains. He left hospital quite well in twelve days. The
stitute
an
contributed
the Lancet at the close of the
to
past
year, and which he has done well to reproduce in the shape of a book published by Messrs.
J. and A. Churchill.*
The idea of
remov
calculi from the bladders of male children
litholapaxy originated
ing by
with
Deputy SurgeonBeaumont, formerly Kesidency
General T.
Surgeon of Indore, who ordered out from England instruments, crushing and evacuating, specially devised for Major Keegan purpose. The present
contains the result of varying i 11 age from If
publication
litholapaxies
58
the purpose. It fell to Surgeonto realize Dr. Beaumont's
on
boys
The issue of the
to 14
years. successful iu every
case
with
one
operatiou was exception of a
" phosphatic concretion which grew round a tilli' stalk in the bladder of a boy of four years, in which crushings were attempted. The
repeated
fully detailed iu the issue of this journal May 1884, aud, strictly speaking, should not
case
for
is
have been included iu this series. Dr. Keegan combats iu detail and
by
the
experience the objections that have agaiust operating ou boys by litholapaxy. These are:?(1) The undeveloped condition of the genito-uriuary organs; (2) the emallness of the bladder; (3) the extreme sensitiveness aud liability to laceration of the
evidence of
been raised
mucous membrane
and
(4)
of the bladder aud urethra ; the narrowness or small calibre of the
urethra. The first two
laige experience which
regaiding ing *
can
the
aud
has
safety accomplished in
be
Lithola'paxy
Surgeon-Major
ease
are
in Male
D. F.
and A. Chukch.il l,
disposed of by the now been gained with which crusha
boy's
bladder.
Children and Male Adults by &c. London: J.
Keegan, M.D^ Dub.,
The
can
be done
in this
boy
by
case
skilful
9^
was
urinary passages is nullified ana3sthetic3, and as regards
sensitiveness of the tl>e
by the
r>
'
boys, and as far as I cau judge, I damaged the mucous membrane of urethra aud bladder, and even if I have
lapaxies the
of lacerating them, Dr. Keegan I have performed nearly fifty lithod
"
remarks: have
of
use
danger iu
never
doue so, vened."
untoward consequences have super-
no
The calibre of the urethra is the cardinal
question as affecting the feasibility of the operation, and on this point Dr. Keegan's experience is explicit and conclusive. He admits that the meatus may be small sometimes, but this can easily be remedied by a slight incision. As regards the rest of the canal he states :?" can
be
point,
no
will admit
scale)
Speaking generally, for there
hard-and-fast rule laid down
this
on
the urethra of a
boy from three to six years or No. 7 No. 8 lithotrite (English
and the urethra of
a
boy
of
eight
ten
or
years will admit a No. 10, a No. 11, and even sometimes a No. 14 lithotrite (Euglish scale)." W itli instruments of that size the crushing of O
calculi of moderate size
plished
iu
Keegan
a
reasonable
claims that the
easily period of
cau
operation
of
be
accom-
time.
Dr.
litholapaxy
possesses the
following advantages over that of lateral lithotomy as a means of removing stoues from the bladders of
safety; objectious
for what
boys, namely?(I)
his statistics show
a
Greater
very small death-rate
(3*5 percent.) aud the cases were not selected. (2) Rapidity of cure; his cases spent on the average about seven days in hospital against 17*61, in oases of lateral lithotomy in boys previously done iu the same hospital ; and (3) The absence of a cuttiug operation. This feature commends the operation to natives of this couutry in a very special manner, and patients will certainly
150
THE INDIAN MEDICAL GAZETTE.
resort
to
for the
hospitals
larger numbers, and, an earlier stage of
know that relief resort to the knife. to
come
out
Keegan has made
of stone in
cure
what is very important, at their malady, when they
a
can
be obtained with-
On the
good
very
whole,
case
Dr.
in favour
to the
cutting operation for stone in children. He adds considerto the value of his book by recording some
of the
crushing
ably practical operation
as
opposed
the
technique of the he has gained from his own inculcates great gentleness in
hiuts
to
as
which
experience.
He
manipulation
and avoidance of much movement
of the lithotrite in the bladder. that the
He recommends
catheters should be furnish-
evacuating
ed with stilettes in order to
dislodge large
and
which sometimes stick in the
sharp fragments
eye of the evacuator, cannot be dislodged by forcible injections, and are apt to lacerate the urethra in withdrawal.
introducing the
operation,
the
use
of
and
attaches
deprecates force in hurry in performing great importance to
completely fenestrated lithotrites
are not so or
He
instruments and
apt
to
get clogged
incompletely
also
as
which
non-feuestrated
fenestrated instruments.
He
valuable
suggestions regarding the gives hard Dr. Keegan stones. of crushing is evidently not enamoured with the suprapubic operation which has lately come into fashion mode of
in
England,
and
as
an
be done in the way of he relates the case of
illustration of. what
crushing very large stones, a man
from whose bladder
he removed in three hours and stone
with
a
half
a
phos-
oxalate of lime nucleus
phatic weighing 2,804 grains (6'4 ounces). au
can
The oper-
litholapaxy has now gained a firm in India, and the work of which we footing ation of
have
given
and scope.
a
summary will extend its
popularity
[May,
1887.
May, 1887.]
cautious
MAY, 1887.
a
working
statement
long
LITHOLAPAXY IN MALE CHILDREN.
of
preliminary injection
Careful
?ln{ Jitdtsit JUijdiiial
149
as
are
of
course
"
this
urine in the
aspirator
Such
necessary.
the
operation lasted as two minutes, and the
three hours and
as
and
water
clear to theeud"?
was
The papers which appear in this number from the pens of Drs. Rate and Goldsmith con-
speaks volumes manipulation.
interesting sequel to the important which Surgeon-Major D.F. Keegan experience
years old, aud the stoue weighed 700 grains. He left hospital quite well in twelve days. The
stitute
an
contributed
the Lancet at the close of the
to
past
year, and which he has done well to reproduce in the shape of a book published by Messrs.
J. and A. Churchill.*
The idea of
remov
calculi from the bladders of male children
litholapaxy originated
ing by
with
Deputy SurgeonBeaumont, formerly Kesidency
General T.
Surgeon of Indore, who ordered out from England instruments, crushing and evacuating, specially devised for Major Keegan purpose. The present
contains the result of varying i 11 age from If
publication
litholapaxies
58
the purpose. It fell to Surgeonto realize Dr. Beaumont's
on
boys
The issue of the
to 14
years. successful iu every
case
with
one
operatiou was exception of a
" phosphatic concretion which grew round a tilli' stalk in the bladder of a boy of four years, in which crushings were attempted. The
repeated
fully detailed iu the issue of this journal May 1884, aud, strictly speaking, should not
case
for
is
have been included iu this series. Dr. Keegan combats iu detail and
by
the
experience the objections that have agaiust operating ou boys by litholapaxy. These are:?(1) The undeveloped condition of the genito-uriuary organs; (2) the emallness of the bladder; (3) the extreme sensitiveness aud liability to laceration of the
evidence of
been raised
mucous membrane
and
(4)
of the bladder aud urethra ; the narrowness or small calibre of the
urethra. The first two
laige experience which
regaiding ing *
can
the
aud
has
safety accomplished in
be
Lithola'paxy
Surgeon-Major
ease
are
in Male
D. F.
and A. Chukch.il l,
disposed of by the now been gained with which crusha
boy's
bladder.
Children and Male Adults by &c. London: J.
Keegan, M.D^ Dub.,
The
can
be done
in this
boy
by
case
skilful
9^
was
urinary passages is nullified ana3sthetic3, and as regards
sensitiveness of the tl>e
by the
r>
'
boys, and as far as I cau judge, I damaged the mucous membrane of urethra aud bladder, and even if I have
lapaxies the
of lacerating them, Dr. Keegan I have performed nearly fifty lithod
"
remarks: have
of
use
danger iu
never
doue so, vened."
untoward consequences have super-
no
The calibre of the urethra is the cardinal
question as affecting the feasibility of the operation, and on this point Dr. Keegan's experience is explicit and conclusive. He admits that the meatus may be small sometimes, but this can easily be remedied by a slight incision. As regards the rest of the canal he states :?" can
be
point,
no
will admit
scale)
Speaking generally, for there
hard-and-fast rule laid down
this
on
the urethra of a
boy from three to six years or No. 7 No. 8 lithotrite (English
and the urethra of
a
boy
of
eight
ten
or
years will admit a No. 10, a No. 11, and even sometimes a No. 14 lithotrite (Euglish scale)." W itli instruments of that size the crushing of O
calculi of moderate size
plished
iu
Keegan
a
reasonable
claims that the
easily period of
cau
operation
of
be
accom-
time.
Dr.
litholapaxy
possesses the
following advantages over that of lateral lithotomy as a means of removing stoues from the bladders of
safety; objectious
for what
boys, namely?(I)
his statistics show
a
Greater
very small death-rate
(3*5 percent.) aud the cases were not selected. (2) Rapidity of cure; his cases spent on the average about seven days in hospital against 17*61, in oases of lateral lithotomy in boys previously done iu the same hospital ; and (3) The absence of a cuttiug operation. This feature commends the operation to natives of this couutry in a very special manner, and patients will certainly
150
THE INDIAN MEDICAL GAZETTE.
resort
to
for the
hospitals
larger numbers, and, an earlier stage of
know that relief resort to the knife. to
come
out
Keegan has made
of stone in
cure
what is very important, at their malady, when they
a
can
be obtained with-
On the
good
very
whole,
case
Dr.
in favour
to the
cutting operation for stone in children. He adds considerto the value of his book by recording some
of the
crushing
ably practical operation
as
opposed
the
technique of the he has gained from his own inculcates great gentleness in
hiuts
to
as
which
experience.
He
manipulation
and avoidance of much movement
of the lithotrite in the bladder. that the
He recommends
catheters should be furnish-
evacuating
ed with stilettes in order to
dislodge large
and
which sometimes stick in the
sharp fragments
eye of the evacuator, cannot be dislodged by forcible injections, and are apt to lacerate the urethra in withdrawal.
introducing the
operation,
the
use
of
and
attaches
deprecates force in hurry in performing great importance to
completely fenestrated lithotrites
are not so or
He
instruments and
apt
to
get clogged
incompletely
also
as
which
non-feuestrated
fenestrated instruments.
He
valuable
suggestions regarding the gives hard Dr. Keegan stones. of crushing is evidently not enamoured with the suprapubic operation which has lately come into fashion mode of
in
England,
and
as
an
be done in the way of he relates the case of
illustration of. what
crushing very large stones, a man
from whose bladder
he removed in three hours and stone
with
a
half
a
phos-
oxalate of lime nucleus
phatic weighing 2,804 grains (6'4 ounces). au
can
The oper-
litholapaxy has now gained a firm in India, and the work of which we footing ation of
have
given
and scope.
a
summary will extend its
popularity
[May,
1887.
