FOREIGN BODIES IN THE BLADDER; REPORT OF A CASE.* Professor of Genito-Urinary Surgery, Kansas City Post-Graduate Medical College. N June 2, 1912, Alonzo T-, male, aged 20, was referred to me, complaining of painful and frequent micturition. He was a young and vigorous lad. Family history was immaterial. The condition of which he complained dated from an attack of gonorrhea contracted a year and half previous and which had failed to yield scopic examination which revealed two medium sized oblong stones and the radiologist, Dr. Skinner, furnished the accompanying picture which shows them quite distinctly. The patient was sent into the PostGraduate Hospital where lithoapaxy was performed. Bigelow's instrument was used. Only a local anesthetic to the remedies and methods of treatment usually employed for posterior urethritis and cystitis. There was no discharge from the penis, and had been none for a year. The two-glass test showed shreds in both glasses. Microscopic blood was also found in the urine. He said that on several occasions after a hard day's work his urine had been tinged with blood. The pain and vesical irritability were increased by exercise. from this history and above mentioned findings we suspected vesical calculus. The diagnosis was confirmed by cysto So was employed in the crushing process. But very little pain was complained of. The stones were easily engaged in the blades of the lithotrite and were crushed many times. Then by the use of the evacuator many fragments were removed and also much was accomplished by filling the bladder with water and having the patient forcibly expell it through the large metal catheter. He could not have assisted in this way had he been given a general anesthetic. These washings were continued until no more fragments came. The patient walked from the *Read before the Jackson County Medical Society, October 4, 1912. operating room, and on the next morning walked from the hospital. The only untoward incident from the operation was an epididymitis which developed on the right side and subsided in a few days. He did complain, however, that there was still something in the bladder and that the flow of urine was suddenly stopped at times. He was cystoscoped again and several irregular pieces were seen. Litholapaxy was performed as before. The fragments could readily be engaged, but on account of their consistency little resistance was offered to the jaws of the instrument. It was unnecessary to use the screw at all. The blades could readily be forced together merely by pushing with the hands. The fragments were chewed in this manner repeatedly. Some detritus was washed out and some removed by the use of the evacuator. But again on using the cystoscope there was still an irregular mass to be seen in the bladder. The waxy and gummy condition of that which remained was such that the lithotrite could not break it in fragments small enough to be passed. A cystotomy seemed to be the only thing left. This was to be regretted because authorities agree that there is more danger in opening the bladder than in the crushing operation and the period of convalescence much longer. He was told to report in a couple of days for operation. In the meantime a careful examination of the fragments showed that the stones were composed of two parts, an outer layer about one-sixteenth of an inch thick of calcareous matter, and a core composed of a blue waxy substance. The shape and consistency of some of the larger pieces suggested a urethral suppository. When the patient admitted he had used urethral suppositories in the treatment of his gonorrhea a year and a half before we were convinced that that was the offending substance about which the calcareous matter had been deposited. These urethral suppositories should be soluble. So some experiments were instituted to find a solvent. Small pieces were put in a half dozen test tubes containing those things which are usually found on one's laboratory table, namely, alcohol, glycerin, hot water, weak acids, alkalies and xylol. It was noted that at the end of five minutes the piece in the xylol had been dissolved. The others had hardly been touched. Some studies were made concerning xylol; it was found to be chemically a dimethyl benzene and the dose internally about fifteen minims. Some was held in the mouth for several minutes and other studies were made to determine its toxicity and irritating qualities. They were found not to be very great. The bladder not being very active as an absorptive organ it was decided that it should be used. The patient's bladder was irrigated with it several times through the large metal catheter. Small particles of the suppository came out each time. Finally after many washings no particles came from his bladder. It was now irrigated with warm water and upon cystoscopic examination was found free of any foreign body. Every particle had been washed out or dissolved. There were no bad effects from the use of the solvent. There was no reaction. The patient was seen for the last time three weeks later. He was well and free from all previously recorded symptoms. Conclusions. The study of this case shows several things: First. A danger in the use of urethral suppositories. Second. A quick, safe way to remove similar substances by the use of xylol as a solvent. Third. In selected cases litholapaxy can be performed under local anesthesia with advantage to the patient. Finally it emphasizes the large value to the patient and satisfaction to the renologist of, taking a careful history of the case, of applying scientific laboratory methods in arriving at a correct diagnosis and finding a remedy. Rialto Building. When the cause of jaundice has been removed, soda salicylate will remove the bile pigment from the blood more promptly than any other drug. Poems the Doctor Should Know "THE DOCTOR'S SON." J. W. SHUMAN, M. D., Centerville, Iowa. 'My son went to college to be a' M. D. An' when he'd become one, he came back to me. He "diagnosed "me, an' I guess I am gone. He said that he feared I had endocarditis, Resulting from chronic cholecystitis. There were "eye ground" distention, and dichrotic intentions, He said I had loss of my gastric secretion, Motorcycle ataxia, beginning but fatal. He said that I 'tended toward hallucination, 66 Said I, Nix, laddie, this is quantum insane." THE MAN WHO KNOWS.. HOMER CLARK BENNETT, M. D., Lima, Ohio. Originality's a diamond, the world its pane of glass, For honor goes to the man who knows, and makes his knowledge count. The golden opportunity stands knocking now at the gate, But will not be there forever, and maybe, when all too late, We will find that while we slumbered, some other fellow come And opened up the wicket and gathered in the plum; Do not put off till morrow, the things that come up today, For fear we should miss the lesson, and still have the bill to pay, So study every problem, and do not dally or shirk, For bus'ness flows to the man who knows, and makes his knowledge work. The man who knows will conquer his foes, and in the fight "make good,' It is practice that makes us perfect, and great will be the fame Of the man who shows the crowd he knows every rule of the game; Let us take heart and do our part, as it comes along our way, For the world soon owes the man who knows, a debt that it must pay. Then here's to the man who knows the game, and hits the mark each shot, Then let us play the game today, and never falter at all, If two are out and the bases full, do not worry a bit, Just keep your eye on the ball, and try to make a home-run hit; Incorporating The Kansas City Medical Index-Lancet An Independent Monthly Magazine Under the editorial direction of CHARLES WOOD FASSETT and S. GROVER BURNETT ASSOCIATE EDITORS P. I. LEONARD, St. Joseph JNO. E. SUMMERS, Omaha CONTRIBUTING EDITORS HERMAN J. BOLDT, New York JACOB BLOCK, Kansas City G. HENRI BOGART, Paris, Ill. T. D. CROTHERS, Hartford, Conn. O. B. CAMPBELL, St Joseph W. T. ELAM, St. Joseph JACOB GEIGER, St. Joseph J. D. GRIFFITH, Kansas City GEO. H. HOXIE, Kansas City JAS. W. HEDDENS, St. Joseph DANIEL MORTON, St Joseph DONALD MACRAE, Council Bluffs L. HARRISON METTLER, Chicago. JOHN PUNTON, Kansas City PAUL V. WOOLEY, Kansas City W. T. WOOTTON, Hot Springs, Ark. HUGH H. YOUNG, Baltimore DEPARTMENT EDITORS P. T. BOHAN, Therapeutics DON CARLOS GUFFEY, Obstetrics JOS. LICHTENBERG, Opthalmology J. ELLIOTT ROYER, Neurology EDW. H. THRAILKILL, Rectal Diseases ST. JOSEPH J. M. BELL, Stomach C. A. GOOD, Medicine J. W. MCGILL, Rectal Diseases OMAHA H. M. McCLANAHAN, Pediatrics H. S. MUNRO, Psychotherapy. DES MOINES WALTER L. BIERRING, Medicine Address all communications to Chas. Wood Fassett, Managing Editor, St. Joseph, Missouri. Vol. XXXI DECEMBER, 1912 Editorial No. 12 A Merrie Christmas and a Happy New Year to our readers. We promise for 1913 a “bigger, broader, and better" Medical Herald. THE SOCIALIZATION OF MEDICINE. "Vanitas, Vanitatem, Omne Vani tas." Conditions that are old and still unsettled in the Eastern states, are now becoming prominent in the Missouri Valley, if we are to judge by the hard "kicks" registered by physicians. We refer to hospital, dispensary and contract-practice evils. Most of the venom is directed against the latter practice. Hospital and dispensary practice in the west does not diminish the chances for obtaining a family practice. Various orders and societies employ medical service at a dollar a year per family. Our medical societies are apparently unable or unwilling to grapple with this condition. The young physician on beginning his medical career finds the profession divided into schools and sects, in his local society he finds it divided into cliques, at eternal war for cases and money. Corporation service, if it pauperizes the general profession has been the stepping-stone of many surgeons where they have won their surgical reputations. Ethical advertising is a fine art, and |