Surgery : its theory and practice / by William Johnson Walsham.

  • Walsham, William Johnson, 1847-1903.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

    716/864 (page 700)
    and 5, orcliitis and epididymitis, occasionally occur. ILovp rarely fi, hfemorrhage, 7, suppression of mine, and b, phlebitis of the prostatic plexus of veins, followed by pya3mia. The impaction of a fragment of the calculus m the urethra (formerly common when the fragments were left in the bladder), cannot occur if the bladder ha^ been thoroughly evacuated. Causes of death.—Death may occui- from 1. Acute ne- pbritis; 2. Pyelitis; 3. Cystitis; 4. Perforation of the bladder; o. Peritonitis ; 6. Saprjemia or pyEemia, or /. Exhaustion. But a fatal termination is rare except when there is some chronic kidney disease. Lithotomy, or cutting for the stone, mav be performed through the perineum or above the pabes. Perina?al litho- tomy may be done in many ways ; the lateral as usuallv performed, and the median will only be described. Lateral LiTnoTOixY.—The patient should be prepared by rest m bed for a few days, and the rectum cleared bv a mild purgative the day before, and bv an enema on the morning of the operation. The bladder should contain five or SIX ounces of urine, or if the patient is imable to retain so much an equal quantity of warm water should be injected. Anaesthetize the patient, inti-oduce a full- size staff with a groove on the left side into the bladder, and try to strike the stone. If the stone is not felt, with- draw the staff and pass a sound. If still unsuccessful, send the patient back to bed as the stone may have been passed per urethram or become encysted. If felt by the sound, re-introduce the staff, but do not operate until the staff itself strikes the stone that you may be sure that the staff has passed into the bladder, and not into a false passage. It is usual to ask an assistant to strike the stone also. Ng^^^ Y>^acQ the patient in the lithotomy position, i.e., with the soles of the feet secured in the palms of the hands by the lithotomy shackles, and brin<r bis nates well over the end of the table. Entrust the staff to an assistant, who should hold it por])endicularly with its concavity hooked avoU u]i under tlie pubos and exactlv in the middle lino. Seat yourself in front of the patient, and having introduced the left forefinger into the rectum to make sure that it is empty, and to induce it to contract, enter the knife (Pig. 257) which should be hold horizontally, a little to the loft of the middle line and about an inch aiid a quarter in front of the verge of tlie anus, and carry the incision downwards and to the left to a point one-third