File:Operative surgery (1899) (14777845004).jpg

Identifier: operativesurgery02brya (find matches)
Title: Operative surgery
Year: 1899 (1890s)
Authors: Bryant, Joseph D. (Joseph Decatur), 1845-1914
Subjects: Surgery, Operative Surgery, Operative
Publisher: New York : D. Appleton and company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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when expanded (Fig. 1375).The dilatation in all the steps mustbe done carefully and in accordance withthe resistance encoun-tered. The prostateand the neck of thebladder can be dilatedone inch without dan-ger. After it is com-pleted a lithoclast(Fig. 1376) of suitable size is introduced and the stone fragmented, afterwhich it comes away with the urine. A small reverse current (Fig. 1388) of warm aseptic and carbol-ized water thrown into thebladder can be used towash the fragments out.Dolbeaus shield (Fig. 1377)for protection of the softparts during crushingshould be employed, espe-cially in severe and pro-tracted cases. Ii eg in aid Harrison, aft-er much experience, ex-presses the belief that theintroduction through theprostate of a small taj)er-ing gorget (Fig. 1314, d)(Teales, Fig. 1314), fol-lowed by dilatation with theindex finger, is a safer andmore satisfactory method Fig. 1374.-Dolbeau.s X \ ^^ °^ entrance to the bladder method, second step. ^*^—^ ^^ this oj^eration than the
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1180 OPERATIVE SUllGERY. use of the Dolbeau dilator, as the hitter is liable to inflict serious injury.Also he advises the use of crushing force))s with blades resembling those ofa lithotrite, with a cutting rib between them, and the handles provided witha screw for strong leverage purposes. The fragments are removed by evacu-ating catheters of the size of the perineal wound—about the size of the indexfinger—and directly by the use of forceps. Harrison regards the operation favorably for the following reasons: 1.It enables the operator to crush and evacuate large stones in a short space oftime. 2. It is attended with very little risk to life as compared with otheroperations where cutting is done, such as lateral or suprapubic lithotomy,and is well adapted to old and feeble subjects. 3. It permits the operatorto wash out the bladder and any pouches connected with it more effectuallythan by the urethra, as the route is shorter and the evacuating catheters areof much larger caliber.

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