CASE.-W. 0., aged 38, a militiaman, was admitted into the Liver pool Infirmary on May 22d, 1877, when I was attached to that insti tution. His statement was to the effect that on the previous night, when under the influence of liquor, a pencil-case had been introduced up his urethra by a prostitute, in whose company he had been. He did not appear, however, to have discovered anything amiss until the following morning,- when certain uncomfortable sensations in the re gion of his bladder made him come to the conclusion that the lost pencil must be there. From his manner I was at first inclined to think the man was insane, but on hearing that the surgeon of his regiment had discovered a foreign body in his bladder, and had sent him to the Infirmary, I at once examined him. Upon doing so with a sound, the foreign body appeared to be lying obliquely, partly in the bladder and partly within the prostatic urethra. I first attempted to remove it by the extractor, described in Reliquet's " Traits des Operations des Voies Urinaires, and known as the instrument of Messrs. Robert and Collin, but failing, a lithotrite was passed. By this the pencil was carried on completely within the bladder, where it was seized transversely. In this position it was impossible to ex tract it; however by gradually rotating the lithotrite toward one side, while the pencil was within the blades of the instrument, I succeeded in reaching one end, when the pencil was removed, point foremost, without any further difficulty or damage to the urethra. The exact
size of the pencil-case is represented in Fig. 35. The patient soon passed urine naturally, and on the following day appeared in no re spect the worse for what had been done.
The difficulty in removing foreign bodies, such as pieces of bougie, from the bladder is due to their being seized transversely by for ceps or the lithotrite. This difficulty Messrs. Robert and Collin have endeavored to overcome by the use of an instrument something like a lithotrite (Fig. 36), the blades of which are so arranged that, on seizing a body, such as a piece of bougie, it is rotated and its long axis is made to correspond with the course of the urethra. The blad der should be partly distended with water before the extractor is introduced.
Perhaps more remarkable than the instance of the, pencil-case just recorded, is one where I removed by cystotomy the whalebone mouth piece of a tobacco-pipe (Fig. 37), encrusted with phosphates. As to how the foreign body got into the bladder the patient must speak for himself.