File:Annals of surgery (1885) (14763403181).jpg

Identifier: annalsofsurgery22philuoft (find matches)
Title: Annals of surgery
Year: 1885 (1880s)
Authors:
Subjects: Surgery
Publisher: Philadelphia Lippincott
Contributing Library: Gerstein - University of Toronto
Digitizing Sponsor: University of Toronto

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perator entirely free to use asearcher or other instrument. Theobturator is suitably grooved at theside to allow for the presence of thesuction-tube. The handle of this speculum ismodified by being fenestrated anddirected upward at an angle ofthirty degrees, so as to keep clear ofthe patients body when turned toone side, and in order that the di-rection of the speculum itself maybe more readily kept in mind(Fig. 2). In catheterization of the ure-ter, and especially in passing a flexi-ble instrument to the kidney for thedetection of obstructions or thedraining of collections, it is of verygreat importance that traumatism beavoided. It is sufficient to use cocainefor all ordinary cases, and if dilata-tion is not carried beyond ten milli-metres, nothing more than a temporary frequency of urination orslight pain will be encountered, providing everything is aseptic.Lubricating oils should be replaced by boroglyceride, and thepatient should lie down for a few hours afterwards, unless accus-
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FlG. 2.—Urethral speculum withinner tube for draining urine (fullsize). 654 GEORGE ERETY SHOEMAKER. tomed to the operation. When using a catheter of small calibrewith eye in the end, it is sometimes observed that some of theurine escapes by the side of the catheter, a fact to be borne inmind in estimating the relative secretion of the two kidneys. Itis safer to wash out the bladder with boric acid solution beforeand after the manipulations, while particular care should betaken that the mouth of the urethra and surrounding parts aremade clean before beginning. Cases are not numerous where the use of the ureteral cathe-ter is necessary, but its field is important and likely to increase.Certainly, all cases should submit to this examination prior to anephrectomy. The writer has now under observation a hydro-nephrosis from obstruction in the ureter, due to old pyosalpinxwhich was removed. Serious danger has threatened from ruptureof the hydronephrosis. Catheterization has shown that nep

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