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Show \lllllllltl'l or LITIIOTOMY. OF THE GORGET. He keeps the nail of the fore-finger of the left hand in the groove of the stall, until he takes the gorget from the pocket of his apron, or the ready hand of the assistant, and fixes the beak into it. and very oblique. The edge penetrating in any degree, on sures the complete incision. The shoulder, which is made on the side of the beak, opposite to the cutting edge, seems to 342'; 01" THE GORGET. DIRECTED by the finger of the left hand, the blunt point 61.9 serve no purpose but, if possible, to thrust the beak from the groove of the stall", and make the surgeon plunge it betwixt the bladder and rectumae. Now, the usual manner of proceeding, is to Withdraw the stall almost instantly, and as if finishing the manoeuvre of the or heal; of the gorget is introduced into the groove of the gorget. stall‘. It is made to grate upon the rough grooves. Now, the surgeon rising from his seat, and secure of being i n the groove of the stall‘, carries the gorget onward, rzcol. i ecting the convexity of the stail‘, and that he has to carry the to the sharp gorget, he will see that there is a danger of the bladder being out upon the gorget, if the instrument be left in the bladder until the forceps be introduced. I think that the gorgct should either be immediately withdrawn, or the staff left as a guard upon the edge of the gorget ; or the gor. gng‘get in the axis of the pelvis, not directly onward. He But if any one look to a contracted bladder, and then moves slowly at. first, until he sees the urine trickling over his get Withdrawn, and the staff left. instrument, when he carries it more resolutely onward, lest the Though I acknowledge that it is contrary to the advice of some celebrated surgeons, for my own part I would advise the gorget to be withdrawn. The forceps can, without a direc- urine escape altogether from the bladder. The gush of urine announces the completion of this incision. I have twice seen the gorget driven between the bladder and rectum. On the dissection of one of these cases, I saw no wound nor sinus between the bladder and rectum. This, for the time, puzzled me, until frequent operations on the dead body gave me examples of what had occurred. The gorget had not gone off the groove : it had only not cut the neck of the bladder, it had pushed the prostate gland onwards upon the stafl‘, and had not pierced the neck of the bladder, nor the prostate gland. This, with bad instruments, and in the re- laxed state of the parts in the lessons on the dead body, is particularly apt to happen. To guard against it, the cutting tory, be introduced at first, as they too often are many succeeding times introduced in operations where some circum» stances prevent the immediate extraction of the stone. If the incision be well performed, nothing will prevent the introduc- tion of ti e forceps; and I conceive the stail‘ to be a better directory than the gorgct, if any directory were required. Further, if by cutting too small a part of the bladder, the forceps were not easily introduced, when we had withdrawn the gorget, then we have the blunt gorget, which being put into the bladder, will, at all events, carry on the forceps with~ * The gorget ought to be of that breadth in the sharp edge, that it may edge of the gorget, near the point, must be extremely sharp, " There ought to be a slight roughness in the groove, or the polish ought not to be given to it ; for I have found that the very high polish makes us less easily distinguish the stafl‘from the surrounding parts. cut through the left side of the prostate gland. If the prostate gland, and the stronger fibres of the sphincter vesicac be completely cut, the wound of the bladder will enlarge to transmit the largest stone. But iftlie base ofthe gland be not entirely out through, there will be a bridling and stricture on the forceps. As the gorget is uniformly of one size, (and, indeed, cannot be made broader Without endangering the cutting of the pudic artery) it has groove. The effect is terrible ; for the gorget does not enter the bladder "‘hoever has doubts of his finger being fairly in the groove of the stafl; let the fault of not entirely cutting through the prostate gland and neck of the bladder. In operating with the knife, in place of the gorget, the incision can him slit up the urethra freely; the only bad effect is the escape of a consid be adapted to circumstances. erablc portion of the urine. vor. 1. I2 ' wom M0997" . |
