File:Modern surgery, general and operative (1914) (14595989068).jpg

Identifier: modernsurgerygen1914daco (find matches)
Title: Modern surgery, general and operative
Year: 1914 (1910s)
Authors: Da Costa, J. Chalmers (John Chalmers), 1863-1933
Subjects: Surgery Surgery, Operative
Publisher: Philadelphia, London, W. B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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ch permits thoroughexploration of the entire bladder. The patient is put in the Trendelenburgposition if water distention is used, but is placed horizontally if air distentionis employed. After opening the bladder as for stone (see page 1332), holdthe edges of the incision apart by means of a speculum (speculum of Keenor Watson) or by retractors, and reflect the electric Hght into the woimd.Growths when seen can be twisted off, a pair of forceps holding the base andanother pair being used to twist, but after removal by twisting they will alwaysrecur unless the base and the mucous membrane about the base is removed.Broad malignant growths may require partial cystectomy. Some growths (asinoperable cancer) are removed piece by piece with Thompsons forceps (Figs.892-894), the base of the tumor being scraped. Such a procedure is merelypalliative. Soft growths are scraped away by a curet, a spoon, or the finger-nail. If bleeding is severe, check it by pressure, by hot water, by a i : 10,000
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Fig. 894. Figs. 892-894.—Thompsons vesical forceps for removing growths in the bladder; for growths close tothe neck of the bladder, with separation of the blades, to avoid nipping the neck of the bladder. solution of adrenalin chlorid, or even by the actual cautery. In some cases thewound is allowed to heal rapidly. In others the bladder is drained for a con-siderable time. In some it is kept open permanently. Permanent drainage isdesirable in some cases of enlarged prostate, and in such cases Senns tube (Figs.895 and 897) or Stevensons tube (Figs. 896 and 898) may be employed. Median Cystotomy (or Cystostomy).—The same incision is made in theperineal raphe for median cystotomy as for median lithotomy. A groovedstaff is introduced and is hooked up under the pubes; an incision is made intothe membranous urethra, and is extended backward for f inch, and a fingeris carried into the bladder. If searching for a growth, find it by the finger.The usual rule has been to catch it in Thomp

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