OCR Text |
Show 252 or Lr'rnorom. or THE Foncnrs. the bladder in one direction does not succeed, another direc- der. And if the stone is very firmly held in the grasp of the forceps, the urethra is very apt to be torn. The handles of the forceps are therefore, when this difficulo ty occurs, to be depressed by the side of the anus, or upon the gut. There the parts yield, if they have been properly tion will. I would observe further, that the forceps are ill-fitted for ascertaining the exact situation of the stone. When there is any difficulty, it is better to take such a sound as I have re« presented, and put it into the wound, then we can touch the . .-,. . ..,_.v~:\~. w' Mitihlfi-ES ' .cut. stone, and, if necessary, raise it from its cavity, if such there should be, and bring it forward. If, having a firm hold of the stone, we find that it does not come easily through, we pass a finger along the blades, to Coagula of blood will often confound the operator-for examine whether the length of the stone is not across the the blood has run backwards into the bladder, and, filling, it Iar‘nlu 253 blades of the forceps. If it should be so, by holding the stone surrounds the stone, so that the forceps close upon a soft mass. less firmly in the grasp of the forceps, and pushing one end of In these circumstances, withdrawing the forceps, we wash out the stone, with the point of the finger it may be brought into the bladder with the syringe and tepid water. But sometimes it happens, from the transverse muscle, or levator muscle, not being sufficiently cut in the external incision, or from the gorget not having cut through the prostate gland and the firmer fibres, which form its sphincter, that the stone cannot be extracted. The Violence used is great. The cries of the patient bear testimony of that Violence. In this case, the surgeon should introduce his finger into the wound, and feeling that either in the lower part of the wound there is a firm bracing of the flesh, or that the incision the more favourable direction for extraction. When the stone is large, and the incision has been made as large as has been safe, and yet it is retained by the forceps of the bladder has a stricture, as it were, which does not yield and dilate, the incision must be enlarged. If the stricture be in the muscles of the perineum, the scalpel must be used to cut across the fibres, while the rectum is pressed down with the fore-finger of the other hand. If the tightness be in the bladder, the probe-pointed history is to be introduced, so as to with difficulty, I have again and again freed the patient from the continued pain of ineffectual eliorts, by introducing my two fingers into the rectum, raising the stone, that the forceps might have a good hold of it, and then assisting the forceps in extracting it, by pushing the stone forwards through the incision; and when the forceps have slipt here, still the stone did not fall into the bladder: it was already in the passage, and I held it there. I have seen a patient, in a public hospital, destroyed by the long continued exertions of the surgeons, merely because they were not aware how inanageable the stone is with the fore and middle finger of the enlarge the incision of the neck of the bladder laterally. left hand in the rectum. When the stone is large, the forceps (though they do in a wedge form make way for the stone) are not to be pulled di- When the stone is firmly held in the forceps, it is then to be slowly extracted. We cannot fail to observe, that it is in rectly outward, but to be used as the accoucheur does his forceps, by movement from side to side. Bringing down one possible to stretch the wound upward, for there is the arch of the os pubis; and again and again I have seen it happen, that blade, it is to be retained in its position, and then by a the surgeon not aware of this, and pulling directly outward, the stone projecting above the blades of the instrument, strikes the parts dilating the stone is extracted. against the bone of the pubis, and is pushed otf into the blarL presumption that there is no other stone; but it is no proof, and we should feel again in the bladder. If there is one side sweep of the handles, the other is to be brought down untll If the stone be brought out rough on all sides, it grounds a ' wan M0999" * |