File:An analytical compendium of the various branches of medical science, for the use and examination of students (1848) (18144333776).jpg

Title: An analytical compendium of the various branches of medical science, for the use and examination of students
Identifier: analyticalcompen00neil (find matches)
Year: 1848 (1840s)
Authors: Neill, John, 1819-1880; Smith, Francis Gurney, 1818-1878
Subjects: Anatomy; Physiology; Surgery; Obstetrics; Medicine; Materia Medica
Publisher: Philadelphia, Lea and Blanchard
Contributing Library: Univ. of Mass Medical School, Lamar Soutter Library
Digitizing Sponsor: Univ. of Mass Medical School, Lamar Soutter Library

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86 SURGERY. An incision is made with a scalpel in the direction of the dotted line of the drawing, (fig. 24,) of about three inches in length, commenc- ing about one inch behind the scrotum, an^ extending downwards and outwards to a point between the anus and tuberosity of the ischium, and even beyond it. Various measurements are given by diflerent surgeons as to the point at which this is to be commenced. No well- informed surgeon should depend upon an absolute measurement, on account of the difference which exists in different patients, with re- ference to the size and depth of the perineum. He should inform himself of the probable size of the prostate gland by an examination per anum, and then, by his anatomical knowledge, make his inci- sion so as to expose the membranous portion of the urethra, taking care not to cut the bulb of the corpus spongiosum in front and the rectum behind. Having cut through the skin and superficial fascia of the perineum, which is very thick, especially in fat persons, the transversus perinei muscle, the transversus perinei artery, the lower edge of the triangular ligament, and it may be a few fibres of the Fig. 25.
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levator ani muscle, must then be divided. By an examination with the finger, the staff may now be felt in the urethra. By means of the finger and nail this space should be increased, and the urethra opened by a bistoury, which will be indicated by a flow of urine. The gorget should now be introduced into the wound, with its beak securely fixed in the groove; it is then pushed in the direction of the bladder, cutting through its neck and prostate gland. Care must be taken to depress the handle of the gorget whilst making this thrust, for fear of wounding the rectum. Urine gushes out, the gorget is carefully removed, for fear of wounding the internal pudic artery, and the finger introduced into the bladder to discover the stone, its

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