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Show 0F LITHOTOMX . srmrroms or THE STONE 1N rm: BLADDER. 239 often dissected the parts for the demonstration of what should be cut in the operation of lithotomy, I could with the same instrument which I' had been accustomed to use, cut the CHAPTER V. parts which lithotomists had determined should be cut; whereas, if I took the gorget, my experience of the form, the firmness, and the relation of the parts, could have been of OF LII‘HOTOMY, VFHE best lithotomists whom I have seen operate, have gone to work with anxious feelings. Cheselden confessed that he suffered an anxiety even to sickness, before operating, and until the immediate call upon his resolution and firmness ba: nished all thought of the precarious nature of the operation, and the anticipation of the infinite variety of ways in which discomfiture overtakes the surgeon. For my own part, I have seen many good surgeons operate; but those who have been the most confident, and boasted the most of their uni- mm ‘. 1 ,t 1 I. 1I s 4 '- form good success, have generally failed in some essential cir= cumstance, when I had the opportunity of attending their operation. Lithotomy is unquestionably the most difficult, and were I to judge by what I have seen, the most precarious operation of the whole circle of domestic surgery. Yet this opipion of the precariousness of lithotomy is founded rather on the many errors that I have seen committe d, than on a conviction that untoward circumstances are unavoidable in this operation. Nay, on the contrary, I have deceived no manner of use to me. I must have proceeded by the mechanical adaptation of instruments in which a knowledge of anatomy was of little service, and by which I should have been subjected to the same accidents which I had witnessed formerly. It is decidedly my opinion, that the knife is the instrument. for cutting into the bladder; and if I conceived that the young surgeon were to be guided by my opinion, contrary to that generally adopted, I should have a very short lesson to give here; namely, the manner of cutting with the knife, But I am writing a systematic work, in which I am bound to consider the common opinion, and the most frequent prac-' tice; bound to give my private opinion in honesty, but not allowed to reject that practice which has obtained the most general suffrage. I have, therefore, to describe the operation with the "orget; to detail how I have seen it prove unfortunate, and how these errors are to be avoided. I shail then describe how I have done the operation, in a boy, and how I conceive the knife is to be used, when the whole operation is performed with the same instrument. myself if I have not been able to trace such errors to their OF THE SYMPTOMS OF THE STONE I)? THE BLADDER, AND 01‘ source ; and I hope to point out how they are to be avoided. SUUNDINC. ' Soon after I became a surgeon, fearful of the mechanical ap- paratus of the grooved staff and gorget, and of the evils I had seen result from it, I preferred operating with the knife. Fear absolutely induced me, in a public operation in the Edinburgh hospital, to lay aside these improved instruments. I doubt not that others attributed to a desire of singularity that which arose merely from the consciousness that as I had Tun symptoms of stone in the urinary bladder are these-- 1. Pain in making water. The pain in passing the urine is of course greatest in forcing out the last drops of urine, when the sensible coats of the bladder contract upon the stone. 2. Often there is a dull pain in the region of the bladder, with an acute and insuiiaabie pain in the glans. The pain is ' wow M09917" '- |