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Show 262 on THE OPERATION WITH THE KNIrL. AMPUTATIOF- If the stone is not readily caught betwixt the blades of the forceps, the finger is passed into the anus, which, lifting up the lower part of the bladder, the stone is put with in the grasp of the forceps, and assisted in" its exit, if it he CHAPTER VI. of great size. This I conceive to be the best way of performing lithoto= my; but I have done it in a boy in the following manner :- Having placed. him in the usual position, and the staff being introduced, I put the fore and middle finger of my left hand into the anus; then striking down the staff upon the stone, I felt it with my fingers, and brought it forward towards the perineum, and to the side of the staff. I now made my incision in the usual place; but instead of seeking for the staff, to cut into it, I out directly on, Alarm" II n \\\\I\\\\I\\m " through the left half of the prostate gland, on the face of the stone. Making thus a fair incision upon it, I thrust it through the wound, by pushing with my fingers in the rectum, as if in the action of bending my fingers. The boy was only three minutes and a few seconds on the table, and was entirely recovered in three weeks: yet this is not an opcv ration which I would do again. The stone slipt from my grasp; and the bladder is not easily out against a rough stone. I believe, too, though this boy never had a bad symptom, that the sphincter of the neck of the bladder ought always to be cut in the operation of lithotomy. OF AMPUTATION OF THE LIMBS. I SHALL here according to my usual manner, introduc. tory to the operation, give a short sketch or view of the diseases which are the occasions for operating. Of the accidents and diseases requiring amputation, it is a very difficult matter to give a short account; and indeed the time has been when I could have given a more decided opinion than I can at present venture to deliver. Sure I am, that the general enumeration in systematic writers is such as will greatly mislead. swam M09917! ,1 One of the most important points settled in surgical books, is, that amputation is dangerous in a robust frame, or system in full health and vigour; and that this danger is increased, wherever there is inflammation, such as that which follows a severe accident. On the contrary, that there is little danger in the operation, when performed on a subject exhausted by irritation, and continued discharges from ulceration. Per- haps the explanation is this, that where the system has been long accustomed to a low degree of action, the tendency to high inflammatory action, is subdued ; so that when the source of the continued irritation is taken away by operation, the body is left in a state susceptible only of that due degree of inflammation from the effect of the knife, which is proper for producing a cure ; the general inflammatory action being low, and the nervous irritation having subsided. But when I say this, I must also bring to my reader's recollection those tremulcus stumps which he must have seen in hospitals, formed of a great sac of loose skin, from the centre of which is presented a long dead bone. This is in gene |
