File:A manual of modern surgery - an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners (1899) (14596125470).jpg

Identifier: manualofmodernsu1899robe (find matches)
Title: A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners
Year: 1899 (1890s)
Authors: Roberts, John B. (John Bingham), 1852-1924
Subjects: Surgical Procedures, Operative Surgery
Publisher: Philadelphia : Lea Brothers & Co.
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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reezing the skinis all that is necessary to avoid pain. There is little pain even with-out this local anaesthesia, if the needle is sharp and thrust throughthe skin with a quick plunge. Litholapaxy. Rapid lithotrity, or litholapaxy, is the crushing and removal of astone at one operation. If the stone is small the operation may be donewithout general anaesthesia by injecting into the bladder four grains ofcocaine hydrochlorate dissolved in four fluid ounces of water. In pro-tracted or difficult cases, general anaesthesia is required. The rectum LITHOLAPAXY. 739 must be empty and the bladder should contain from four to six fluidounces of warm sterile fluid. It is well to have the pelvis of the patientslightly elevated; and the bladder should have been irrigated a feAVtimes in the preceding days to make it at least relatively aseptic. Oilis then injected into the urethra, and the lithotrite, well anointed withglycerin, introduced into the bladder. A tape or rubber drainage tube Fig. 408.
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Forbess lithotrite. may be tied around the root of the penis to prevent escape of thewater in the bladder. The shaft of the instrument is held at an angleof about 45° with the operating table and with its beak depressing alittle the floor of the bladder. The male blade is drawn out about aninch and a pause made to allow the stone to fall between the jaws ofthe lithotrite. If it is caught, the lithotrite is locked, after a slightmovement has been made toinsure that no mucous mem-brane has been caught on thejaws along with the calculus.The male and female bladesare then slowly screwed to-gether to break the stone.Other stones or the fragmentsare seized successively andground into small particles. Ifthe surgeon fails to catch thestone, the lithotrite is turnedfrom side to side in the bladderwith its jaws open until thestone is grasped. It may benecessary to invert the beakof the instrument, in order toseize a stone lying behind theprostate gland. The finger of an assistant inserted into

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