Stone in the bladder : lithotomy in the infant and the child ; crushing the stone in the adult and old, with the application of lithotomy to each, in certain cases, practically considered / by Richard G. Butcher.

  • Butcher, Richard G. H., 1819-1891.
Date:
1870
Catalogue details

Licence: Public Domain Mark

Credit: Stone in the bladder : lithotomy in the infant and the child ; crushing the stone in the adult and old, with the application of lithotomy to each, in certain cases, practically considered / by Richard G. Butcher. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    the entire of the membraneous portion of the urethra by the one and continuous stroke of the knife. This should be the surgeon's aim, for if the knife be introduced again and again Avith the inten- tion of clearing the staff, the difficulties of completing the operation are greatly increased; the urethra is wounded and notched in several parts; shreds of it may hang into the groove of the staff, and impediments so offered to the blunt-pointed knife, so that it cannot travel fi'eely or with security to the division of the prostate and neck of the bladder. But graver consequences may still follow this imperfect division of the membraneous portion of the urethra. It may be so injured by the repeated wounds that the remaining connecting tissues may fail to resist the efforts essential to the completion of the operation, and give way, and so the surgeon may thus be foiled in reaching the bladder. The mem- braneous portion being fairly divided throughout, the blunt- pointed bistuory is to be introduced into the grooves of the staff, and immediately the index finger of the left hand into the angle between it and the staff. The right hand presses the blunt point firmly to the staff, and at the same time onwards towards the bladder. While the index finger of the left hand is in contact Avith and pressing it in the same direction, both arrive at the rudi- mentary prostate, the onward movement being still continued, the back of the knife resting in the pulp of the finger, the sharp projecting edge slightly lateralized makes sufficient division, and both enter the neck of the bladder. The wrist of the right hand now is slightly lowered, and pressure downwards and to the left side gently made, with the point of the finger resting on the bistuory to the extent deemed necessary. The blunt knife and the finger being within the neck of the bladder, the blunt instru- ment may be laid aside; and now, and not until now, can the staff be taken out with safety. Upon the finger is then introduced the blunt gorget in the manner already described, and upon it the forceps. It is much safer, in the young or old, to conduct the forceps by the gorget to its destination than upon the finger; first, because it will travel through a smaller space; secondly, and most important, the liability of the instrument's slipping aside and unnecessarily separating parts, even to the passing between the bladder and rectum, is done away with and guarded against. The forceps passed along the finger seems more showy to lookers-on; but greater security is insured to the patient by conducting the