File:The practice of surgery (1910) (14799099713).jpg

Identifier: practiceofsurger00mumf (find matches)
Title: The practice of surgery
Year: 1910 (1910s)
Authors: Mumford, James Gregory, 1863-1914
Subjects: Surgery
Publisher: Philadelphia and London, W. B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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through a suprapubic cystotomy. In the case of thin women and in yoimg children it is often possibleto palpate a stone bimanually, with one finger in the vagina or rectumand a hand above the pubes. The treatment of stone in the bladder is a subject older than his-torv, as I have intimated, and from the earfiest times even fairly rationalmethods of extracting calculi have maintained. Obviously, a simpleand straightfoi-ward manner of opening the bladder is the old one of 400 GEXITO-IRINARY ORGANS passing a staff, or sound. tlii()U<:li tlic urethra and cutting upon it, bythe perineal route, until the hhukler is opened. That was anci(!nt prac-tice. In more modern times the bladder was oj^ened by the lateralperineal route, a method still employed occasionally. Another ancientpractice, popularized in recent years, is suprapubic opening of the bladder,while a fourth method, in great vogue during the past thirty-five years,is to crush the stone within the bladder by instruments introduced
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Fig. 244.—Litholapaxy; crushing the stone (diagrammatic). through the urethra, and to wash out the fragments. This last procedureis known as litholapaxy. Litholapaxy.—Jean Civiale, in 1824, was the first successfully to per-form the operation of crushing a stone.^ He did not wash out the frag-ments but left the patient to pass them. Many experimenters worked 1 Lithotrity: crushing a stone. Litholapaxy: lithotrity followed by promptremoval of fragments of the stone through a tube, by suction. STONE IN THE BLADDER 401 to perfect a better tcchnic, until Henry J. Bigelow, in the last quarterof the nineteenth century, developed the modern operation, crushingand evacuating at a single sitting—litholapaxy. For the generalsurgeon, and with suitable cases, litholapaxy is the operation of choice.The tcchnic of this procedure was graphically described by Bigelow ina brilliant series of articles published in 1878 and subsequent years.The instruments required are lithotrites of various sizes

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