The Use of a Bag Pervious to Air in Ether Anaesthesia
Authors: W. M. Young
Journal: BMJ (1901)

On average he micturated at half-hourly intervals, day and night.Just previous tohis aaifinision liere'tzisWiitrval was reduced to five minutes.This act was always productive of a varying ainunt of pain and strain- in.The p*4n always preceded micturition, and increased in intensity as his desire to micturate increased.This pain, which was cutting in character, always shot from his perineum to the end of his penis.He had had retention of urine several times.There was no history of gonorrhcea, or evidence of tuberculosis in any other organ, or in his relatives.Dr. Robertson has seen him at odd times during this period; he never discovered anything that would lead him to suspect tuberculous disease of the testicles.The patient has been married seven years, and his only child was born five years ago.Sexual excJtement orcoitus made no difference as regards his pain.Up to a year ago he had a more than usual number of erections.His urine used to be " thick and gravelly," but for the last twelve months -up to his admission here-it has been " clear."He has never seen any blood-stained semen, but on three occasions his urine has been blood stained.Exposureto cold has, so the patient thinks, brought on these attacks.It has certainly aggravated them.Condition on Admission.The patient looked neurotic: at any rate he took a morbid delight in detailing his symptoms.He complained chiefly of pains in the perineum.At times these were constant, and lasted for two or threc days; again they might be mere shooting pains.The pain was aggravated by micturi- tion, and sometinmes by defmeeation, when violent rectal tenesmus followed.If the pain lasted long it was dull and boring, with shooting pains at intervals.He was obliged to micturate every half-hour.He had pain in the lumiibar region, shooting down the outer side of the right leg.The right testicle was very slightly larger than the left; the enlargement wds general.This, the patient said, had its origin in a kick on the testicle when a boy.The patient was vely tender to a rectal examination.By this means an irregular nodular mass, firm to the touch, and hardly the size of the little linger, could be detected on the right side of the base of the bladder.The swelling com- menced immediately above the prostate and extended upwards, back- wards.and slightly outwards, keeping close to the bladder.The prostate was normal in size.The passage of a sound produced great spasm, and free bleeding after its use.The urine was blood-stained for three days.No evidence of stone in the bladder or kidneys could be detected.On microscopical examination the urine revealed pus cells, crystals of triple phosphates, and tubercle bacilli.The lungs were healthy.The patient was kept under observation for sonie timije.There was no improvement in his condition, and as far as could be ascertained the disease had not infected any other part of the genital apparatus.It was then decided to excise the seminal vesicles.Operation.On March 21st, igoI, the patient was chloroformed and fixed in the lithotomy position.A sound was introduced into the bladder and the sphincoter of the anus stretched.A semilunar incision, 3 inches in length, with its concavity forwards, was nmade across the perineum, an inch in front of the anus.The soft parts were retracted, and the dissection down to the.vesiculte seminales was niainly done with a blunt dissector and scissors.All the bleeding points were twisted.Both vesiculhe seminales were seen to be enlarged.The soft tissues around them receded so readily that some difficulty was experienced in getting a firm hold of them, in spite of the help given by the sound in the bladder and two fingers in the rectum.Ligatures were placed and both vesiculae removed in tlieir capsule.There was some oozing deep down in the wound; this was stopped by plugging with iodoforin gauze.The edges of the skin incision were brought together with silkworm sutures, one being omitted to allow of a piece of the iodoform gauze to come through and act as a drain.A rubber tube was placed in the rectum to prevent any tension there, due to the accumulation of flatus.March 22nd.Tie patient had passed a good night.The urine came naturally, and was deeply blood-stained.He complained of slight pain in the region of his bladder.A portion of the gauze was pulled out and the rectal tube retmioved.March 23rd.The patient is quite easy.More of the packing was removed.The urine contains abundant stringy mucus, and a slight amount of pus.March 24th.He has still a little hypogastric pain.On removing a further portion of the packing about 2 drachms of serous fluid escaped.The wound is healthy.He now retains his urine for from two to three hours.March 25th.The patient is very well.The whole of the packing was removed, 2 ounces of serous fluid escaping.A small rubber drainage tube was inserted.MarCh 26th.The drainage tube was removed.There is scarcely any discharge.A probe cannot be passed into the wound.Some of the outer stitches were removed.A simple enema was given which cleared the bowels.March 28th.-The remaining stitches were causing slight irritation, so they were removed.Urine is passed every three or four hours.He is not inconvenienced any way, and has no pain.April 2nd.A rectal exatination was made; it was not painful.The vesiculae seminales could not be detected.April 7th.The pastient was discharged.Wound soundly healed.There was perfect relief of all his symptoms.From the operation onwards his temperature has been normal.