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Show 2.5!) HALMORRHAGY. HJEMOXRHAGY ,. 2 ' 2' the quantity of blood such as to indicate the cutting of a main artery 9 and the loss so great, that in the event of a re, ‘ ' 1') an "mum,_ w. 7 1" , artery goes twisting under the ramus of the pubis, and dives I _ ,. \‘. \ ~--.-- ".6. .s.‘ ‘ lllltltlll turn of the hremorrhag' , the patient's life or health may be hi danger P The blood must flow either from the transecrsalisperinez‘, or from the artery oft/w bulb, or from the trunk of these the internalpurlz'c. The first of these is always out ; the second too often needlessly, and yet it is not easy assuredly to avoid it ; the last is often out and the patient dies. Three of our first operators have each, within the last year, lost a patient by haemorrhagy: yet this is the most inexcusable cause of failure of any. 1. The transversalis perinei must be cut, because it runs directly across the course of the incision : it supplies the muse cles and fat of the perineum. 2. The artery of the bulb is a large artery, it need not be cut if we make the course of our incision for the fore-part of the prostate gland, not for the bulb, which I have ventured to say, is the part most generally cut, in all its length. The deep into the bulb of the urethra. Sometimes it passes across 0 low that it must be in the course of the incision. I think I have seen this artery cut in a boy, and cause fatal lliE= morrha gy. By pushing the knife too directly into the angle made by the bulb of the urethra and the ramus ischii, this artery is struck. If it shall still be the object of the lithotornist to cut for the membranous part of the urethra directly behind the bulb, he cannot avoid cutting this artery 3 but if he dissect for the face of the prostate gland, and pierce the membl‘an' ous part of the urethra just before the gland, he may avoid it. When I have seen this artery bleeding powerfully from the penis, I have thought of its importance when out near its division, from the more superficial artery in the perineum. It is, however, most necessary of all to observe the occasion of wounding the trunk of the internal pudic .rtery. It may be done either by the knife in the first incision, or by the gorget. When the surgeon is fearful of wounding the rectum, and keeps too near the tuberosity of the os ischii, or when he mis~ takes the feeling of the protuberant part of the bone for the inner margin, and does not calculate how much nearer the inner edge, and consequently the internal pudic artery lies to the anus, than the centre of the tuberosity is which he feels through the fat of the hip, he is in danger of cutting this artery. To avoid the trunk of the arteries, then, we must take the anus as our direction, and keep near to it. If the finger be introduced into the anus, we shall find the gut contracted, and we may cut close upon the coats of the gut ; nay, some have kept the finger in the rectum, to make this incision more securelya‘s. I have said too, that the bulging part of the staff should not be thrust so far aside; it serves no purpose but to distort the parts, insure the surgeon's cutting into the ' mam mosey"! bulb of the urethra instead of the membranous part, and making him out nearer the bone than necessary. r' In pushing in a broad gorget, unless the staff be made to yield towards the right side, so that the gorget may come more into the centre of the arch of the pubes, the trunk of the internal pudic artery is in great danger. As in other operations, the surgeon should judge by the first jet of blood, and by the direction and size ix'hat arte- ry he has to deal with. If the blood springs with force from the side of the wound, and upon feeling there you find that you are nearer the bone than you imagined, let the ar~ tery be taken up by the tcnaculum before proceeding. When the operation has been tedious, all bleeding from small branches will have ceased. If the bleeding continues after the operation, it is not a trifling artery. It is not so much during the operation, or when the patient is on the t The rectum is generally cut in the deep part of the incision; and it is to be protected by pushing the rectum doxmwrrd, and to the right side, with the fore-finger of the left hand, VOL. 1'. K 53 |