FOREIGN BODIES IN THE BLADDER.
By accident or design foreign bodies occasionally become lodged within the bladder. Among the miscellaneous articles that have been found in this position I can recall to mind pins, needles, wires, a lucifer match, a knitting-needle, a slate-pencil, a feather, a bulb headed grass, pieces of catheters and bougies, a whole bougie, and a pencil-case ; but, taking the experience of others, this list might be considerably extended. Most of these things have been introduced for the purpose of acting upon the penile portion of the urethra—for reasons best known to the patients themselves—and have subsequently made their way into the bladder. In reference to the movements of foreign bodies, my impression is that the vermicular action of the urethra is an ejaculatory one, and that such a body is only forced ward the bladder when in its form it presents an obstacle to its out ward passage. A piece of bougie, with its anterior extremity broken and uneven, and its posterior end smooth, placed in the urethra, is sure by the vermicular action of the canal to be forced in a direction toward the bladder by the effects that are made to expel it. I will mention some cases where foreign bodies have been passed into the urethra, as serving to illustrate certain points in practice.
CASE.—In 1861, I saw a youth, aged 16, who was suffering from some induration in the ischio-rectal fossa and perineum. On in quiring into his history, it was found that eighteen months previously the patient had passed into his urethra a needle, which, having slipped from his grasp, disappeared. Not liking to mention it, he refrained from seeking surgical advice. He appears to have suffered very little inconvenience up to within a week from his being seen, when he had pain about the perineum and difficulty in micturition. As fluctuation could be felt in the ischio-rectal fossa, an incision was made, and some matter evacuated, but no needle was discovered until the finger was passed into the rectum, when the sharp point presented in front. A median perineal opening was made and the foreign body removed. It
was largely encrusted with a deposit of phosphates. The patient re covered rapidly, no urine escaping through either of the incisions.
Mr. Mitchell Banks has given me the particulars of a case he had seen where a needle had been passed up the urethra by a boy three days previously. On examining by the rectum he could feel the blunt end of the foreign body, and was able to force the point through the perinaum and thus to extract it. In the following instance I removed from the bladder of a middle-aged man a bougie, twelve inches in length : CASE.—The bougie had been introduced by a surgeon as a guide to a urethrotome, with which it was intended to divide a stricture by internal section. Unfortunately the bougie separated from the ure throtome just beyond the point where it was attached by means of a screw. The surgeon at once divulsed the stricture by Holt's method, and left the bougie in the bladder for extraction on a future occasion. I saw the case fourteen days after the accident. As the urethra would by this time admit a No. 12 bougie, I had no difficulty in introducing the lithotrite and extracting the bougie, which I seized about the cen tre and brought out doubled; it being soft and of small size, the re moval was accomplished by merely gentle traction. The patient re covered without a bad symptom. The bougie appears to have remained curled up in the bladder; no calculous deposit was observed upon it, although it had been retained for a fortnight.
It is possible that the extraction of long bodies offering greater resistance, such as thicker catheters and boogies, might be facilitated by first dividing them with Caudemont's cutting lithotrite, and then extracting them in portions. The case just narrated points to the ne cessity of care being exercised in properly securing the connecting links between urethral instruments and the guides now so frequently used in connection with them.
Among the more remarkable objects that have found their way into the bladder is a bulbous grass, as in the following case: