No.371.

LONDON, SATURDAY, OCTOBER 9. [1830-31.

IMPROVED MODE OF OPERATING

IN

LITHOTOMY.

By GEORGE WALKER, M.R.C.S.

ABOUT six years ago I operated for thestone upon a boy two and a half years ofage (in the presence of several medical gen-tlemen of this neighbourhood); upon thisoccasion I used a beaked knife instead ofthe gorget (otherwise the operation wasconducted after the usual manner) ; afterthe incisions were made into the bladder,the forceps were introduced and searchmade for the stone with them, but not beingable to find it, after two or three seconds Iwithdrew them and introduced my fore-

finger, when upon curving it and turning it

up towards the pubes, I immediately feltthe stone at the front and upper part of thebladder, when I introduced the forceps andextracted it; upon examining the stone, asmall filament was found attached to it, bywhich I make no doubt itwas suspended fromthat part of the bladder before described ;although, upon this occasion, I was success-ful, I resolved that when again called uponto perform lithotomy, I would avoid, 1st, theuse of the beaked knife, which, after it wasintroduced into the groove of the staff, Ifound inconvenient in determining the exactextent of the incision I wished to makeand, secondly, although I had made a mode-rate-sized opening into the bladder, I foundit most advisable to withdraw my finger be-fore I passed the forceps again, rather thanrun any risk of lacerating the wound bypassing them (the usual lithotomy forceps)along my finger as I had originally pur-posed. I therefore, preparatory to two

operations which I performed on the 2ndult., had forceps constructed resemblingvery much in size and curvature the com-mon polypus forceps ; but in the union ofthe blades, action of the joint, hollowingout and roughness of the jaws, in every re-spect the same as the lithotomy forceps.I operated upon these boys, the one being

four the other eight years of age, in thepresence of my friend Dr. Warden, surgeonto this dockyard, and several other pro-fessional gentlemen of this place in the fol-lowing manner :-after the usual incisionsinto the groove of the staff with the scalpel,I continued the incisions with the same in-strument under the guidance and guardian-ship of the fore-finger of my left hand,through the prostate gland, &c., until it

(my finger) passed 1’eadily into the bladder,when I desired the staff to be withdrawn,and my finger came instantly into contactwith the stone; I then passed the forceps(before described) along my finger, and

grasping the stone as soon as they were in-troduced, I extracted it without any delay ;the operation was conducted after this man-ner in both cases. The boys both rapidlyrecovered. What I infer then is, that in-stead of feeling (ineffectually) with the for-ceps as I did in the first case, and as is

usually recommended, I had a very superioradvantage by passing my finger through thewound immediately after the knife, and byfeeling the stone therewith, was enabled topass the forceps and grasp it at once, with-out any delay or difficulty whatever. The

forceps I have had made give the advantageby their curvature of being readily passedover the finger upon the stone, let it befound in whatever situation it may, and bytheir smallness are easily so conveyed with-out fear of laceration, and are equally as

strong as the common forceps.Sheerness, 1830.

INSTRUMENT

FOR DIVIDING THE CORNEA IN

EXTRACTING CATARACTS.

PERMIT me, through the medium ofTnELANCET, to publish the plan of a new me-chanical contrivance for making the incisionin extraction of cataract. The number ofinstruments which for this purpose havebeen from time to time devised on the Con.tinent, where the subject receives more at.

66

tention than it does here, sufficiently proves, Ithat to obviate the difficulties of the ordi-nary method is yet a desideratum, and ren-der it unnecessary to insist here on the fact, Ithat long practice only can confer the ad- (dress requisite for gtuding the knife withsafety, by the ordinary process, through thedelicate structure of the eye.

If hy the means I am about to propose,security and facility be attainable without anexperience injurious in its first essays, sur.gery will be much indebted to mechanics,aud an operation, now confined to a fewwho have gone through a tedious probation,will be placed within the reach of any onewho gives but ordinary attention to the sub-ject.

Description of the LM<t’M7KeM<.Fig. 1, front view. Fig. 2, back view.4, the blade, acting upon a centre at 13,

and impelled by a spring. C, a perforatedplate, with bevelled edge, through whichthe cornea is to project. D (fig. ), anotherperforated plate, with a larger aperture,and edge moie bevelled, which rests uponthe globe of the eye. E, a screw, by turn-ing which, the upper plate, together withthe blade, is raised or depressed, as the va-rying convexity of the cornea may require;it is, however, seldom found necessary to

alter the elevation of the plate.In using the instrument, the blade is first

to be set up by pressing it from the positionthrown by the dotted lines to its present po-sition, A. The operator then opening thetids with the left hand, places the instru-ment on the eye, having the forefinger of the1&Icirc;ght hand on the button, and taking carethat the edge of the cornea corresponds withthe circumference of the hole in the upperplate ; or, in other words, that the surfaceof the plate be brought to a level with theplane of the iris : this is accurately per-formed by means of the screw. The instru-ment being thus adjusted, it is only neces-sary to keep it close upon the eye, when,by pressing on the button G, fig. 2, with thefore-finger, the blade is liberated, and thespriug carries the point through the cornea,making a section of half its base. This being Idonp, the instrument should be removed,

I

and extraction proceeded with in the usualmanner. If, however, after the introductionof the capsule needle, it be necessary inorder to protrude the lens, to make slightpressure on the eye, it cannot be moreequably and safely performed, than by the

reapplIcation of the instrument.’llie advantages of this method of operat-

ing, may be brieflv enumerated as 1o11ows :The use of the instrument being of easyacquin-meut, and capable of steady andaccurate adjustment, the important advan-tage of an incisioo of proper sizp. ia ensused,

the want of which is not infrequently a

cause of failure. The smoothness of theincision is of consequence in facilitatingunion and preventing the cicatrix being, assometimes happens, a great bar to vision.The rapidity with which the blade passesthrough the anterior chamber, does not allowtime for the aqueous humour to escape be-fore the incision is completed, and thus themost frequent cause of the iris being woundedis avoided ; the quickness of the motionalso, by causing little or no pain, preventsthe mischief which sometimes arises fromthe swerving of the patient. Another advan.tage is, that while the eye is rendered immovable, the distortion produced by the

ordinary method of steadying with the fingeris avoided, ahd the chance of giving exit tothe vitreous humour, is thus diminished.In conclusion I have only to add a hope,

that if the instrument be adequate to theend proposed, it may not be sacrificed to aprejudice against mechanical contrivances,which, because they render skill unneces.sary, are thought unworthy of the skilful.If, on the contrary, there be solid objec.tions to its employment, I shall regret its fai-lure, only because there will still remain adifficulty unobviated, and a source of evil to

i the afflicted unremoved. I remain, Sir,Your obedient humble servant,

THos. R. WILLIAMS.17, Norfolk Street, Sept, 1830.

DISEASE OF THE VALVES OF THE RIGHT

SIDE OF

THE HEART.

By WILLIAM THOMPSON, Surgeon.

IF the editor should consider the follow-ing case worthy a column in THE LANCET,he will oblige me by its insertion, It appearsto me important, as illustrating a rare occur-rence in pathology, viz. disease of the valvesof the right side of the heart, a diseasewhich, I believe, many experienced morbidanatomists have not had an opportunity ofobserving.

The lady was forty. eight years of age;the principal symptoms which were ob-served, connected with the disease of theheart were, orthapnoM, increased on theleast exertion, occasional attacks of palpita-tion and faintness; the beart’s action moreextended than natural, but the impulse notincreased; the pulse feeble and irregular.The patient gradually sank, and died on the16th of last month.On examining the chest, about two pints

of amber-coloured fluid were found in the

right cavity, but aone in the left. The