Hæmoptysis, with Suppuration of Right Lung, and Hypertrophy of the Heart

John P. Harrison
1844 Boston Medical and Surgical Journal  
sion of urine, from the effects of which the patient in all probability would die. But this may be modified, as you see here (showing the instrument), where you have no curve in the instrument, but merely a straight catheter, having at its extremity a Stilette, which, by means of a screw at the opposite end, may be made to protrude any required distance. I will tell you of a case in which I first employed it. A man who had previously been under the care of Mr. Earle, at Bartholomew's Hospital,
more » ... olomew's Hospital, was admitted here and placed under my care ; he had stricture, and 1 never could pass a catheter for him ; 1 therefore had him taken to the operating theatre, and I cut into the pcrinoeum on the left side of the raphe ; then dissecting down to the urethra, I laid it open behind the stricture; and having passed the instrument I have just shown you into the urethra, and drawn the penis as forward as possible, I passed one finger of my other hand into the opening of the urethra close under the symphysis pubis, and then screwing out the Stilette, and being guided by my finger, I pressed it forwards through the stricture. Having clone this, I removed the instrument, and replaced it by a common gum catheter, which I left there several days to prevent the irritation which would have been produced by allowing the urine to flow over the part, and the patient entirely recovered. I can recollect the time when the surgeon used to cut into the perinoeum, and, what was called, dissected out the stricture : 1 say " what was called," for, in fact, ihe surgeon did not know what he was doing ; this I have from persons who saw the operation performed. I never saw it done in this hospital, but it has been done in others. 1 have been told that sometimes the surgeon succeeded, but in most cases the patients died : and certainly it does appear absurd, when there is an operation so simple as the one I have been describing, to venture on one extraordinary in itself-dangerous in its consequences. When the opening has been made, as directed in my operation, the catheter is immediately passed, which entirely prevents effusion taking place. In the two last cases you have seen in the Hospital, the instrument could be got through the stricture, but the difficulty was this : it always produced a fit of shivering, so that it could not be allowed to remain. The operation you saw me perform the other day was as follows : I cut down into the perineum till I could feel the staff at the part where it passed through the prostate gland ; then, turning the knife forwards in the groove of the staff, I divided the stricture in the direction of the penis, and I could feel that 1 was cutting through a hard gristly substance. The question then was, whether an instrument was to be passed through the urethra, or the opening made in the perineum? The latter was decided upon, and the patient is going on tolerably well. The urine is already alkaline.-London Medical Times.
doi:10.1056/nejm184407030302203 fatcat:xgnemdhk4vaargvvons5hhmddm