A 
NEW METHOD EMPLOYED 
FOTl 
REMOVING A URINARY CALCULUS 
FROM THF. 
URETHRA. NEW METHOD EMPLOYED 
FOR 
REMOVING A URINARY CALCULUS 
FROM THE 
URETHRA. 
Prof. ALDEN MARCH, M. D. 
ALBANY: 
VAN BENTHUYSEN & SONS’ STEAM PRINTING HOUSE. 
1867. A NEW METHOD EMPLOYED 
FOR 
REMOVING A URINARY CALCULUS FROM TflE URETHRA. 
Velpeau says : “ When calculi are found lodged behind the 
meatus, or in the fossa navicular is, it rarely happens that the 
efforts of the bladder and the volume of the urine will not be 
found sufficient to expel them.” But when these means do not 
succeed, he adds, “ we should proceed to search for them by the 
dressing forceps, the point of which is somewhat concaved and 
flattened ; or, as Sebatier recommends, by gliding underneath 
them a noose of iron or brass wire by means of a small scoop 
shaped like a hook ; or. finally, if these should fail, or be attended 
with too many difficulties, by incising the lower wall, of the urethra 
in front of the stone.” 
Before we proceed to comment upon the above manual or 
mechanical means of extracting a calculus from the urethra, it will 
be proper to notice the sheathed forceps, an instrument somewhat 
of the character of that used for holding the stone in the process 
of drilling, and thus breaking it up, as practiced many years ago 
by Civeale. A similar instrument has been used for extracting 
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bullets. 
The instrument herewith exhibited will give some idea of its 
design, and how efficiently it may be employed for either purpose. 
I will remark, however, that I never used it successfully in extract- 
ing a ball, but on one occasion I employed it with complete suc- 
cess in extracting a calculus from the forepart of the urethra of an 
adult. 
We think the dressing forceps can hardly be made available if 
the calculus is lodged more than an inch back of the fossa navicu- 
laris, for the simple reason that the orifice and anterior part of the 
urethra would prevent the blades from being sufficiently opened 
to permit grasping the stone. 
Those of us who have practiced noosing a bottle cork, when 
lodged in the bottle, with a piece of twine or wire, and have ob- 
served the manner in which the noose acts on the cork, to turn it 
diagonally, or more or less crosswise in the neck of the bottle ; 
and especially, when we consider the lax condition of the lining; 
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membrane of the urethra, its folds, rugae, &c., I think we may 
safely say, that the noosing plan would be tedious and uncertain, 
if not of doubtful utility. 
And lastly, the scoop shaped like a hook could not be easily 
passed by a calculus which was sufficiently large to fill up the 
urethra, so as fairly to hook upon and to act efficiently on its pos- 
terior extremity. 
When the calculus is lodged some distance back from the orifice 
of the urethra, and cannot be dislodged or extracted by any of the 
above means, authors recommend urethrotomy, or cutting through 
the urethra upon the stone, at its under side, and thus extract the 
foreign body. In this way there is not much difficulty in extract- 
ing the calculus; but the danger of a fistula, and the trouble of a 
long process of treatment, and the uncertainty of effecting a cure, 
should lead us to hesitate and to exhaust all other reasonable ex- 
pediencies before resorting to the use of the knife. 
It has fallen to my lot to have had the management of some ten 
or a dozen cases of urinary calculi in the urethra. I have also 
seen several cases of fistulous openings in the urethra, and in two 
instances failed to close them up, by any and all the varied means 
which I zealousty and persistently brought to bear upon them. 
The cases of lodgment of calculi in the urethra that have fallen 
under my observation have been mostly in small boys. I can 
now bring to mind a very interesting case of a small boy, about 
six years of age, who had been attended for some days, or nearly 
a week, by a country physician, for suppression of urine. Diu- 
retics and warm fomentations had been employed freely, till the 
bowels, as the physician supposed, had become enormously 
distended. On making inquiry as to the history of the case, and 
on percussion, I said to the doctor, “ The bladder of your patient 
is full of urine, and there is great danger of the urethra giving 
way,” as the penis and urethra were much inflamed near the 
testes. As the urine had been passing away from the little patient 
almost guttatim, I presume the attending physician had supposed 
the bladder was emptying itself. I attempted to pass the catheter 
into the bladder, and after traversing the urethra about an inch 
and a half, it came in contact with an obstruction—what appeared 
to be some foreign body—in short, like a small calculus. The 
catheter was withdrawn, and by the aid of the fingers, the stone 
was soon worked forwards to the orifice of the urethra, when it 
became necessary to divide it in the direction of the frenum before 5 
it could be extracted. After this trifling operation the stone was 
readily extracted, the catheter introduced, and nearly a quart of 
urine drawn off. I believe the urethra either ulcerated or sloughed 
at the seat of the deepest inflammation, which resulted in a fistula 
that ultimately healed up. 
The recent case, which gave rise to the chief or most important 
idea of our paper, is the following : 
Samuel Baird, aged 30, a shoemaker by trade, and a resident of 
Albany, N. Y., was admitted to the Albany City Hospital, January 
22d, 1867. He was an industrious, sober man, and had usually 
enjoyed good health; though some years ago he was troubled 
with dyspepsia for a short time. 
Three years ago he began to suffer from severe pains, com- 
mencing in the region of the right kidney, and passing down to 
the testicle of the same side, giving the sensation as if a hard 
rough body had descended through the ureter to the bladder. 
The pains were severe, and would last from two hours, to all day 
or night. 
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At times the urine was bloody; and often in micturating, some- 
thing would seem to “ shut off,” to use his own language, and at 
once cause intense pain. 
Before entering the hospital, the patient had been sounded by 
Dr. Becket of this city, and two or three times by myself. The 
grating sound or sensation was more distinct than a regular klick 
—the characteristic sound of a large and hard stone, when the 
steele sound is brought against it suddenly and sharply. The 
symptoms, we must confess, were not quite as satisfactory as I 
could have wished, to enable me to decide on the propriety of 
lithotomy—and yet there seemed to be no other alternative. 
The day before the appointment for the operation, the patient 
took an infusion of buchu freely, and at night a dose of purgative 
medicine, which operated freely the next morning. At 9 o’clock 
a. m. he felt some hard body pass from his bladder into the 
urethra, and to take lodgment in front of the testes. The patient 
said he had felt similar sensations during the latter part of the 
night, while in the water closet, at stool. On examining the 
urethra a calculus was distinctly felt situated in front of the scro- 
tum, of considerably large size. 
Complete anesthesia was effected by ether and chloroform, when 
the process of dislodging the foreign body was commenced, in the 
presence of most of the medical staff of the hospital, several 6 
medical gentlemen of the Legislature, citizens, physicians and 
medical students, by urging it forwards with the fingers. In this 
way it was at once started, and brought within about an inch and 
a half of the orificium urethra, where it seemed to resist all 
further effort by such means alone. At this juncture, I seized a 
large sized steel sound, which lay near at hand, and passed it into 
the urethra down to the calculus, by which the passage was 
expanded, somewhat like that of the mouth of a bag, by the 
fingers, when an effort is being made to fill it with any bulky 
material. With the sound thus fixed in contact with the stone, 
the manipulating process, with the fingers, was again resumed, by 
which both stone and sound were extruded from the urethral 
orifice. 
The calculus, as will appear from the examination of the speci- 
men herewith exhibited, is of that class of urinary deposits called 
“ mulberry calculus.” The color and physical configuration, 
appear considerably like the fruit of the mulberry. 
Dr. Mosher, the professor of chemistry in the Albany Medical 
College, applied two or three tests to determine its chemical com- 
position, which resulted in his finding oxylate of lime. I believe 
this variety of calculus is not often met with; perhaps not oftener 
than once in thirty or forty specimens of urinary calculi. Its 
asperities and general rough surface, will account for the bloody 
urine occasionally passed by the patient. The chief point of 
interest in our case, consists in what we claim to be a new and 
simple method employed in removing the calculus from the 
urethra. 
The sheathed forceps, or bullet extractor, as we will now 
demonstrate, with a piece of India rubber tubing, I think, may 
answer a valuable purpose, especially in the adult. 
I do not know that so small an affair, and a thought or 'principle 
so simple as that which was made available in accomplishing an 
important object, is worthy the consideration of the Society; if not, 
I beg pardon for consuming, even a few moments of its valuable 
time.