Barnard Holt
1860 The Lancet  
SURGEON TO THE WESTMINSTER HOSPITAL, ETC. MR. ALLARTON'S operation for stone in the bladder having engaged the attention of operating surgeons, it behoves all those who have had an opportunity of performing it to record their experience of its results. The main objections which have been hitherto urged against its performance have been in reference to the size of the stone and the enlargement of the prostate gland, the consequent difficulty of extraction, and the effect of forcible dilatation
more » ... the neck of the bladder. Having lately performed this operation three times, where these difficulties were prominent fea. tures in each case, I desire to record the results. J. R——, a child aged eight years, was admitted into the Westminster Hospital under my care, April, 1860, suffering from stone in the bladder. The symptoms had existed for eight months prior to his admission, and consisted in difficulty and frequency of micturition, which required considerable straining to effect; occasional passage of bloody urine; and, but rarely, pain at the extremity of the penis. The boy having been placed under the influence of chloroform, a sound was passed to the neck of the bladder, where its further progress was arrested by some foreign body, which a slight amount of pressure sufficed to displace. The sound being thus fairly introduced, a stone was immediately detected, which, from the extent of surface traversed, appeared to be large. I decided on performing Mr. Ailarton's operation. On May 8th, while under chloroform, a staff as large as the urethra would admit was introduced, and the stone immediately detected. The child was now secured in the ordinary manner, and the forefinger of the left hand being passed into the rectum, the exact situation of the prostate was ascertained. A sharppointed and somewhat triangular knife was now thrust into the mesian line of the perineum, with the back towards and about three lines in front of the anus, the finger in the rectum guiding the knife, and preventing its being wounded. An incision was now made directly upwards, and the groove of the staff cut into by opening the urethra immediately in front of the prostate; and the knife was now run backwards and forwards to a slight extent so that it might be fairly divided, the tegumentary opening being enlarged as much as appeared necessary in its withdrawal. The forefinger was now removed from the rectum, and passed into the wound, with the nail in
doi:10.1016/s0140-6736(02)55704-4 fatcat:dvf6xvxcyrcqjlzhh25mjw2tj4