The Lumleian Lectures ON SOME DISORDERS OF THE SPLEEN

1904 The Lancet  
1636 that the urine cannot be easily stopped. It is a double tube and you can wash through from one into the other. In addition, you can always get it to syphon out. It ought to syphon out anything which is contained in the bladder. You put the short stem into the bladder and the long stem over the side of the bed into some vessel and have it syphon into carbolic lotion. This particular drainage-tube has deprived the operation of very many of its terrors. Altogether it is a device of very great
more » ... evice of very great service. Now let us take the other case in which you close the bladder. If you have removed the small papilloma and the wound in the bladder wall has been closed, and supposing that the bladder interior is not septic, it is safe to close the bladder forthwith. And the way one does that is as follows. A fishing-gut suture is passed through the skin, through the abdominal muscles, through the muscular layer of the bladder wall, and up through the opposite i side and tied, and that brings the bladder and mucosa close together. In the absence of sepsis this succeeds exceedingly well. We have had three cases in which it has been safe to close the bladder wound immediately in that manner, and I believe I am correct in saying that each of the three patients was walking about the ward at the end of three weeks. And that is of great advantage, because if a drainage-tube is put in it will be from six weeks to two months before the patient will be able to get about properly. With regard to the subsequent history of these cases of bladder growth, when done in this particular way I believe the outlook is favourable, but as yet not many have been done freely and thoroughly. When done in the ancient way of tying bits of string or rubber round the pedicle or by clamps put round the pedicle the operation is futile, and if I had the misfortune to have an epitheliomatous tumour of the bladder I would decline to have such a proceeding performed upon me. In conclusion, I will say this to you : everybody here ought to practise using endoscopes and all the other scopes. If a man can use the ophthalmoscope properly he will soon be able to use the endoscope and otoscope, and these instruments have been enormously improved of late. This endoscope which I show you has got a lamp which does not produce heat, it keeps quite cool, it has got an apparatus for catheterisation of the ureter, and also an arrangement for putting some additional fluid into the bladder. It is also useful if you want to distend the bladder a little more or to withdraw some of the fluid or if you want to see how much blood there is, and in fact it is a highly convenient instrument, and it is also better arranged than the ordinary run for disinfection. There is no gentleman here who could not if he chose to practise with it soon become expert in its use.
doi:10.1016/s0140-6736(01)77148-6 fatcat:c4c6enuwc5e6nokz2n3p3jxb7u