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Show UK" PUNCTURING THE BLADDER» or mums THE "Dorian. 229 the end of the canula) it is introduced alongst the fore finger, which is in the rectum. The short stiletto is now pushed from its sheath, the canula, and the point of the stilette takes the place of the point of the left finger, which is pressed upon the bladder. It is then pushed into the bladder, in the direction of the gentle curvature of the instrument, which answers to the axis of the pelvis. Let me not fail to say, that I have seen the puncture above the pubes answer every end, and that it is performed by surgeons whose opinion I value. Nay, it may be thought advisable after the operation above the pubes, to continue the operations by caustic, on that dis ease of the urethra which produced the necessity of puncturing. 1 'p But, in this case, we must be careful that all lenders . 03/ to inflammation in the bladder has subsided. ‘l , Hi | -‘ ,, 0F TAPPING THE ABDOMEN. what 1 war-mu nuru‘. mm «mi: ,7 But if the obstruction has been nearer the bladder, it may be owing to an enlargement of the prostate gland; and the surgeon would do well to satisfy himself whether the tumou r which he discovers above his finger, be not the prostate gland, instead of the lower bulging part of the bladder. This, if he possesses any tact, he will be easily able to do by attending to the solid resistance of the tumour of the prosta te ; when, by stretching the finger over it, and pushing it deeper into the rectum, the more elastic bladder will be found beyon d it. l' l 9143-:- u,_q_=,.=‘u.-m<m- - _... - _ If the tumour of- the prostate gland be not very large, there is no ditiiculty in puncturing the bladder through the coats of the rectum. In a case of the largest gland I BVCI' saw, I still prefer the attempt to puncture by the rectum ; for I conceive it still to be practicable while we can feel any part of the bladder. The operation is simply this, having oiled the fore finger 0f the left hand, it is introduced into the rectum, and curving it upward, the bladder is felt. Then having the long trocar, proper for this case, in the right hand, (with the sharp point. of the stiletto drawn within Tm: ascites is a disease which sometimes brings the ques tion to issue betwixt the physician and surgeon. A patient, with whom the physician has inefi‘ectually tried his skill, is thrown into the hands of the surgeon as a last resource.- The surgeon ought not to operate by the will of the physi~ eian, but to judge by symptoms of the propriety of the operation, and the likelihood of advantage resulting from it. In ascites, the urine is generally small in quantity, and of a. deep colour, with thirst, and feeling of heat, there is a fre- quent pulse, the breathing is affected; upon applying the hand on the belly, and striking it with the other, there is a distinct feeling of fluctuation. Dropsy of the peritoneum is very often an accompaniment and consequence of debility; a part of a universal dropsy. We naturally inquire, has the swelling of the belly followed an increasing anasarca, or did the swelling of the abdomen precede the anasarcous swelling of the legs? for the latter may be a consequence of the mere pressure of the former. if the anasarcous swelling of the lower extremities has be , ' vmm M0999" ! |