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Show 01‘ SOUNDING AND fEELING THE STONE. When the staff, A, is introduced into the bladder, it may happen that the stone, B, lodges under the level of the urethra, and of the course of the sound ; consequently we have to force or strike down the convex part of the sound. This lodgment of the stone under the level of the sound, [have found upon dissection, In this slight sketch it is seen how the finger introduced in? to the rectum may come to the aid of the sound, and by pressing up the lower part of the bladder, ascertain the presence of the stone, and even inform the surgeon of the size of the stone. To ascertain the size of the stone, I conceive to be a very 11er ccssary, though a frequently neglected duty of the surgeon. It may happen that the stone is lodged to one side, dropping as it were by the side of the rectum ; when, the sound must be pressed laterally and downward, to strike upon it. But when there is any lodgment of the stone in a particular part of the bladder, or when at any time there is diiliculty in ascertaining the presence of the stone, it is better to use the "lid silver catheter, which, though it do not convey the vibration equally with the steel sound, will yet answer this purpose sufficiently ; while it has this advantage, that you introduce it with a full bladder, and feel in all possible directions, and with every variety of posture of the patient. On letting the urine run through the catheter (while it is still held), if a stone be in the bladder, the contraction will bring the stone in contact with the instrument. Sounds should be formed with various curves ; but one less curved than the common catheter will go down behind the neck of the bladder, and touch the stone, when a longer in-strument, with alarger curve, may pass over it. When spasms afl'ect the bladder, and the instrument is closely embraced, and not allowed to move freely, the patiellt may be put into the warm bath, and when the influence of the bath is on the system, the operation may be done. OPERATION FOR THE STONE, THE OPERATION. 1 DO not imagine that a continued low irritation from the stone is unfavourable to the operation of lithotomy; but it need scarcely be said, that all Violence of symptoms must have subsided before the operation be attempted. If there are pains in the kidneys and loins, the operation must be delayed, as new stones may be descending. Before the operation, by mild laxatives, and natural food (in kind and in quantity) the body should be reduced to the heaithy standard, if the patient has been accustomed to luxurious living. If, on the contrary, he has been long exhausted, and the health is impaired by long sufl‘cring, he must be recruited by repose and nourishment. Ixsrmrnnxrs, &e. THE staff, of the size and form with the sound which you have previously used-Sealpels-The gorget-Blunt gorget -A probe-pointed bistory (lest it should be necessary to on. large the cut into the bladder)--Forceps of various sizes, some curved (and let care be taken that they be well tempered, since I have seen them bent and twisted in the operation)- A scoop for the sand, which may be abraded from the surface of the stone-Sponges and tenaculum-Gartcrs to tie the patient-An injection-bag and pipe, or large syringe, to wash out the bladder, when the stone is lying among firm coagula, preventing the chuck of the forceps against it, or to cleanse the bladder of the broken pieces of stone.-I would recommend also a searcher, made in this form, to, ascertain the position of the stone, and to bring it forward if it lie in a sac or depres sion of the bladder. ' VlUNl M099?" ! |
