Manual of minor surgery and bandaging for the use of house-surgeons, dressers and junior practitioners.

  • Heath, Christopher, 1835-1905.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Manual of minor surgery and bandaging for the use of house-surgeons, dressers and junior practitioners. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    A small calculus may become impacted in the urethra of a child, and thus produce retention either partial or complete. Frequently the calculus is arrested just within the meatus, and can be extracted with a small scoop ; but if farther down, urethral forceps must be employed. If the house-surgeon is unsuc- cessful in his attempt to extract the calculus in this manner, the visiting surgeon should be summoned to cut down upon it without delay, since an impacted calculus may give rise to extravasation of urine by causing ulceration through the urethra.- The same rules would apply to a piece of calculus impacted in the urethra after lithotrity, though in that case, if the fragment is near the bladder, an attempt may be made to push it back into that viscus with a large catheter or bougie. Retention in the female occasionally requires the use of the catheter, though, since it is generally an hysteri- cal symptom, the use of instruments kc. should be avoided as much as possible. The patient should never be exposed for the passage of a catheter, but she should be placed on her back with her knees drawn slightly up. Standing on the right of the patient, the surgeon will next pass the left hand between the thighs, and place the forefinger just at the orifice of the vagina. An elastic catheter can then be readily introduced with the right hand, and being made to glide over the forefinger of the left, will almost infallibly enter the urethra, being felt through the wall of the vagina immediately beneath the arch of the pubes as it passes to the bladder. The so-called tubercle at the orifice of the urethra is generally imperceptible, and likely to be confounded with the clitoris ; and it is therefore safer to disregard it altogether, and to proceed as suggested above. Extravasation of urine may occur either from the urethra giving way after prolonged distension of the bladder, or may be caused by the unskilful use of the