File:Surgery, its principles and practice (1906) (14586620650).jpg

Identifier: surgeryitsprinci04keen (find matches)
Title: Surgery, its principles and practice
Year: 1906 (1900s)
Authors: Keen, William W. (William Williams), b. 1837 Da Costa, J. Chalmers (John Chalmers), 1863-1933, joint ed
Subjects: Surgery General Surgery
Publisher: Philadelphia and London : W. B. Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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nesthetic at all isnecessary. The posterior urethra and the vesical neck are the points requiringthe anesthetic influence, the anterior urethra and bladder Avall in generalrequiring none at all. The favored mode of securing this effect has been that of depositing20 or 30 minims of a 4 per cent, solution of cocain in the posteriorurethra, after emptying the bladder of all contents. The solution thusdeposited is not inclined to remain in the posterior urethra, but under theinfluence of the muscular apparatus surrounding the canal passes backinto the bladder and soon mixes with the urine as it comes from theureters. It is thereby diluted, and its effect is transient. While this DIAGNOSIS OF VESICAL AFFECTIONS. 287 method is serviceable to a degree in patients not extremely sensitive,it is not satisfactory where there is a state of inflammation and super-sensitiveness; to meet which conditions I some years ago devised andhave been using with much satisfaction the urethral tablet depositor
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Fig. 162.—The Bransford Lewis Urethral Tablet Depositor. depicted in Fig. 162. With this instrument tablets of either cocain oralypin or novocain (one-half to one grain each) are deposited well withinthe posterior urethra, are allowed to rest there for a minute until macerated,and then, by to-and-fro movements of the depositor, are spread over themembrane in that neighborhood. A thicksmear and confined application of the drugresult from this mode of using it, and theeffect is much more serviceable and lasting.Since the posterior urethra and bladder pos-sess little absorptive power, there is littlelikelihood of observing toxic effect from thisprocedure, even where two or three grains ofcocain are used. Alypin and novocain areconsiderably less toxic than is cocain, and arealmost equally as effective. Loss of sensitiveness of the vesical neckmay be tested by further manipulation ofthe depositor; which, when attained, is fol-lowed by filling of the bladder with clear fluidand the introd

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