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Show 2.38 or THE ornna'riox as rem-easier) IN THE W'ESTMINSTER HOSPITAL. table, that the danger of hmmorrhagy is great, as when it re- turns three hours after, or on the evening subsequent to the ope. ration. This second hmmorrhagy added to the loss of blood instead of the gorget, the bistouri cacfiie is introduced along during the operation, is too much, and the patient cold and pale after it, sinks. Sometimes a third slighter haemorrhav gy proves fatal. If the blood flows from under the arch of the pubes, :.till the compression or tying of the same vessels commands it. If the bleeding shall not seem to demand the needle, there is a canula, which. being wrapped round with lint, or passed through a piece of sponge, may be introduced into the wound; by pressing against the es ischii, it stems the bleeding from the lesser branches of the pudic, while it al- iows the escape of the urine. The patient must be kept cool, and with the precaution recommended in the intro duction. If there be pain, tension, and fulness in the bladder, some little time after the operation, it may be full of coaguluni, which both excites the bladder and retains the urine. The finger may be gently insinuated, and then the injectin g-bag and pipe used to inject some tepid water into the bladder. OF THE OPERATION AS PERFORMED IN THE "'ESTMINSTER HOSPITAL. MR. LYNN and Mr. Carlisle have of late practised the operation of Frere Cosme. I wish that gentlemen of less knowledge and ability in their profession, had revived this operation. The same errors I still conceive are apt to be committed in this manner of operating, which were proved to have attended that of Frere Cosme. The operation has certainly the advantage of simplicity, and of the mechanic» 31 way of operating; there is in this, the least fear of not getting into the bladder. A staff of the common kind is in troduced into the bladder. The first incision is made in the common way; the urethra is cut in the same piece, and in the same manner; but 235$} the groove of the stati‘, into the bladder. The staff is then withdrawn. The history is then taken in both hands, and turned so that the edge of the knife shall present to the left side of the bladder, and the spring being so pressed, that the knife rises from the groove, in which it has lain concealed, the instrument. is in that state and relation to the bladder withdrawn with one uniform continued pull. The incision is here made into the bladder in the common direction, and it is intended to be the same extent. The ope- ration is conducted in all other respects as the operation with the gorget. The objections made to the operation of Frere Cosme stand in full force here: and these have been often set forth in sufficiently dreadful array. It has the advantage which was claimed by the supporters of Frere Cosme, the dexterous and the awkward, the ignorant and the anatomist, may per form it with equal security; but still with equal chance of doing mischief. 1. The urine is apt to escape before the incision is made. This multiplies the danger. For then the knife being raised and spread in the bladder, and drawn thus out, it may cut up the whole. side of the bladder. If the knife be rats-r ed, and the incision not immediately made, the contracting bladder must be particularly in danger of being cut upon the sharp point of the knife. If the knife be adapted to cut the prostate gland, and a very little of the neck of the bladder, on the supposition that the bladder is distended, it will cut more than sufficient if the urine has escaped. Further, in operation with the gorget, it is possible to turn the edge obliquely downward, in adapting it to the groove of the staff, so that its edge is not made to run along the bone ; but with this instrument before the incision of the neck of the bladder is made, it is drawn up to the bone, and when the knife is drawn out. it must come close upon ' wow; M099» |