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Show .350 or LITHOTOMY. or THE roncnrs. $251 out the danger of the sharp gorget remaining in the bladder at a time when it suffers such extreme excitement and must, of consequence, strongly contract. When the gorget is withdrawn, it should be pressed towards the right side of the perineum, that the edge may not make a. second incision. the pelvis. not grasp it. Now, perhaps, he touches the stone, and still can- A very little knowledge of the parts, and can perience of the difficulties of the operation, inform even a spectator of what is going forward. In this diliiculty, with most distressing feelings, I have seen an operation continue for an hour, when by putting the finger into the rectum, and raising the lower part of the bladder, all difficulty of grasp- 01‘ THE IORCEI'S. ing the stone would have vanished. Wars the forceps are introduced, the surgeon should not immediately begin, with both hands, to separate the handles When the operator cannot with ease and perfect certainty introduce the forceps either at first, or in the second or third attempt, he ought to use the blunt gorget, and be sure that. of the instruments, and to dive and chuck for the stone; but g endeavour to feel for the stone with the forceps closed, and ascertain its exact position before he attempts to seize it. When the surgeon is grasping for the stone, and cannot even make the stone sound till he has overshot it in the manner here represented, he must raise his hands, and point the in« strument almost perpendicularly down into the lower part of menu‘s mm s- e he touches the stone with the forceps, without any intervening substance; for it has happened, that thc,operator has sometimes pushed the side of the bladder before his instru» ment, and along with the stone seized the side of the bladder betwixt the teeth of the forceps. We not unfrequently see a surgeon pressing the forceps deep into the right sinus, and hitting upon the stone, then it ' vmm M0997" ! escapes into the left side; he follows it there, and thus trilles in ineffectual, yet painful endeavours. This notion of sinuses of the bladder, by the sides of the rectum, is a mere decep- .. tion. There are no such cavities. When the surgeon turns the handles of the forceps to the right side, and the blades, of course, deep into the left side of the pelvis, and then again into the other side, in the same manner, he is not moving the instrument in the relaxed bladder; but the bladder is con- tracted about the stone; it is moveable in its place; it is carried upon the end of the forceps ! This I have ascertained. After seeing this changing for some time, I have put my finger into the bladder, and found it closed (but soft and wrinkled) about the stone, and accurately adapted to the form of the stone. To seize the stone in this situation, it is only necessary to extend the blades of :1, the stone. B, direction of the forceps overshooting #10 stone. C, necessary direction to seize t/zc stoma bladder. the forceps, which, stretching the bladder, the stone comes to occupy the space betwixt the blades; and, on closing them I), "1' gently, the stone will be found there. If this stretching of e |
