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Show POSITION OF THE PATIENT IN LITHOTOMI. rmsr rscrsron FOR LITHOTOMY. Let the surgeon be sure of the adaptation of the beak of the gorg't to the groove of the staff. The gorget, I think, should grasp the sole of the foot; and then tying the ligature around be of a shape to announce its full entrance into the bladder ; that is, a little behind the cutting edge, it should be narrowed, and particular care should be taken that the cutting edge, where it is near the button or probe-beak of the gorget, do not stand too abruptly oil, and that it be extremely sharp at that place. If it should be with somewhat of a blunt, perpendicw Iar edge, to the beak which is to run in the groove of the staff, it must cut the urethra With difficulty, and push the prostate gland before it. That this is possible I have demonstrated on the dead body, by running a blunt gorget in its whole course on the stall, and yet the bladder has not been opened. If the surgeon has done as he ought, in informing himself of ..- Mar/Nu ‘ 7 . *‘ * " vexity of the staff is felt in the perineum. The staff is now given to the assistant, who holds it firm in the position in which he receives it, having the thumb of the left hand over the head of the staff, and the scrotum supported by the right hand. In regard to the staff, there is one thing more, particularly to be attended to, Viz. that by the assistant's carelessness the point of it be not brought out of the bladder, and made to rest in the neck of the bladder. Be sure, then, that by ele‘ vating the handle of the instrument, you can push it smooth ly onward in the bladder. I much doubt the propriety of using L61 the perineum be shaved, and the rectum emptied by an ,_ ' , [‘7 himself at a convenient height; and taking the handle of the staff, presses it a little towards the right groin, so that the con for breaking the stone. them. enema. If you were to cut, while the point of the staff rests in the neck of the bladder, when you had fixed the gorget in its The terror of the patient, and the irritation of the groove, and you were about to thrust it forward, and at the bladder, may prevent the bladder from being distended with same time to carry the stall‘ farther into the bladder, ten to one but the staff would not pass easily, perhaps not at all. Then water ; yet I consider a few ounces of urine in the bladder as ._s_. . «fl v.13. ...~ so absolutely essential, that we should ensure it even by tying a soft tape round the penis, when necessary. withdrawing the gorget, and still endeavouring to pass the staff, its point might be carried through the slit you have made in the urethra ! Tun patient is seated on the edge of a strong table; a Pil‘ Now the surgeon must have calculated all the bearings 02 the anatomy, and especially felt the prominence of the ischi- um; and he would do well to remember that the margin of low is under him; then laying him down upon the table, the shoulders and head are supported. The staff is now intro- the bone reaches somewhat more inward than the prominence which he feels. By the surgeon not attending to this, I hate duceda-z and then the feet and hands are tied together, by seen the pudic artery out. POSITION 01' THE PATIENT. putting a noose of tape over the wrist, making the patient . FIRST INCISION. { .A-‘g-u,g-ng.=,_uw~_ . . * If the sound, without a groove to directthe hand, should be introduced; i' " the hand and foot. ' 'I‘he breech now presented over the table, the surgeon seats: the size of the stone, there will be no occasion for instruments Ilvn "It 4 tilltltl" "be as I have set-n, the consequence is terrible if the surgeon cannot operate "3‘11 the knife. For when once the urethra is laid open in search of the gl‘OOVC: and none found, the sound cannot be withdrawn, and the staff introduced. It is at least more apt to pass out by the out into the urethra than into the bladder. We are directed to begin our incision on the prominence of the staff, and, cutting through the skin and integuments, to carry it down between the verge of the anus and Hip isChL urn, or somewhat below the isehium. ' mom M09917 |