[Reprinted from the Boston Medical and Surgical Journal of 
February 19,1891.] 
THE REMAINS OF A BROKEN LEAD-PENCIL 
(SURROUNDED BY PIIOSPHATIC DEPOSITS), 
AND THE METAL TIP OF THE PENCIL RE- 
MOVED FROM THE BLADDER BY PERINEAL 
SECTION. 
GEOKGJE H. MOSKB, M.D., BOSTON. 
Last spring a patient came under my care in the 
surgical wards of the Carney Hospital, with a violent 
cystitis, resulting, as he said, from the presence of a 
lead-pencil in the bladder. He stated that sometime 
during the preceding October he had pushed a lead- 
pencil into his urethra for the purpose of “ opening 
the passage for the water to run.” He declared that 
he had suffered with stricture, and that he had intro- 
duced the pencil after a vain attempt to urinate. The 
patient was rather stupid, and he would not or could 
not give a very satisfactory account of the affair. 
The pencil, when introduced, was between three and 
four inches in length. It was an ordinary lead-pencil, 
with a piece of rubber attached to one end, while the 
other was bluntly pointed. The rubber was kept in 
place by a metal collar. 
In some unexplained way the pencil, while in the 
urethra, escaped from the patient’s grasp, and managed 
to slip into the bladder : a circumstance which ren- 
ders the story of the stricture extremely improbable. 
Shortly after this, the patient was obliged to seek 
surgical assistance on account of the intense pain, vio- 
lent tenesmus and frequent desire to micturate, which 
resulted. He been twice etherized 2 
and operated upon, and that he was told after the 
operations that attempts had been made to remove the 
pencil through the urethra, that the pencil had been 
crushed and several fragments removed, including the 
rubber tip, and that the nickel collar still remained in 
the bladder, with possibly a few fragments of the pen- 
cil itself.1 
Months went by until the patient came to the Carney 
Hospital. This was in April. He was suffering tor- 
tures from pain and tenesmus. The urine was filled with 
sediment, and its odor was foul. A foreign body,— it 
seemed like a stone,— was readily detected by the 
searcher, and it was decided to do perineal section. On 
April 12th, the patient being under ether, I opened the 
bladder by the perineal route, the incision being made 
upon a staff and in the median line. 
With my forefinger pushed well into the wound I 
could feel a foreign body ; it was rough on the out- 
side like a stone. Owing to the depth of the perineum 
I had some difficulty in catching the body with forceps 
and extracting it. 
At last I was successful and it was removed. It 
was a little over two inches long (see Fig. B), was 
slightly curved and appeared to consist principally 
of phosphatic deposit. A considerable piece of macer- 
ated wood protruded from one end, while the other 
end was smooth and was moulded into a blunt point. 
During further examination of the bladder the metal 
collar was found and removed. This collar (see Fig. 
A) was distorted, its shape suggesting that of a cocked- 
hat ; and from one end projected macerated wood. The 
thread on the collar was quite distinct. The cut rep- 
resents the two bodies in their actual size. 
11 subsequently learned from the surgeon in charge of the case 
that his intention had been to make an opening into the bladder later, 
and remove the metal collar, hut that the patient would not submit 
to another operation and had disappeared. 3 
The bladder was thoroughly washed out, a drainage- 
tube inserted and a T-bandage applied. 
The patient’s recovery was rapid and uninterrupted. 
The bladder was washed out daily with antiseptic so- 
lutions, and all signs of cystitis gradually disappeared. 
The perineal wound healed rapidly and urine began to 
METAL COLLAR WITH 
THREAD FOR RUBBER 
■MACERATED PERCH-WOOD 
MACERATED 
WOOD PROTRUDING 
EXTREMITY MOULDED TO F/T 
THE /ALTERUAL MEATUS OR A POUCH. 
flow through the penile urethra. About three weeks 
after the operation the patient left the hospital with a 
small perineal opening, through which occasionally 
escaped a few drops of urine. 
REMARKS. 
The larger specimen was evidently a heavy phos- 
phate deposit about a nucleus of macerated pencil- 
wood, part of which I have already mentioned as 4 
protruding from one end of the mass. The smooth, 
blunt point at the other end was of such shape as to 
suggest that it had rested either in a pocket or in the 
internal meatus of the urethra. 
Prof. E. S. Wood, to whom the specimen was shown, 
was inclined to think that the body lay on the floor of 
the bladder with its convexity downwards, and that the 
blunt-pointed extremity rested in a pouch, probably 
behind the prostate. 
The distorted shape of the metal collar, already re- 
ferred to, suggested that it had been squeezed and 
flattened at its two extremities by the powerful jaws 
of the lithotrite, but that, unfortunately for extraction, 
this flattening had been made in different diameters 
at the two ends, thus making a body whose smallest 
diameter was too large to permit its extraction airough 
the ordinary urethral tubes. 
It would seem that the operation of crushing and 
washing should be restricted to the removal of calculi 
and of such substances as will, when crushed, break up 
into separate fragments of such size and shape as 
to readily engage the tube and pass through it; and 
that all other bodies should be removed by an im- 
mediate opening into the bladder. 
I should not neglect to mention that the bodies, at 
the time of their removal, were very foul smelling. 
They were kept for three days in fresh running water, 
and even at the end of that time, the odor about them 
was distinctly perceptible.