File:The principles and practice of surgery (1916) (14577586218).jpg

Identifier: principlespracti1916warr (find matches)
Title: The principles and practice of surgery
Year: 1916 (1910s)
Authors: Warren, Richard, 1876-
Subjects: Surgery Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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sed. Rectal and vaginal examination may reveal a stone in the lower ureter.The urine may be acid or alkaline and even ammoniacal, or may containblood (often in microscopic traces only), crystals or pus, none of which aredefinite evidence of stone. With the cystoscope the absence of vesical disease may be determinedand the orifices of the ureters examined. A rounded, patulous or puffyorifice and tli« passage of pus or blood in the efflux or absence of the latterpoint clearly to the side affected, though not giving complete proof of thepresence of stone as opposed to other renal disease. Finally, bougies may :>■>! A TEXTBOOK OK SUROKKY lie passed up the ureter arid tin point of obstruction noted ; of more serviceare the bougies impregnated with iron-oxide (Fenwick), which are opaqueto X-rays and give useful information, confirming the location of the met. 1and the shadows of doubtful stones contained therein. X-rays. By the employment of radiography the surgery of renal calculi
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Fig. 178. Renal calculi (oxalate). has been improved enormously as regards accuracy of diagnosis, and X-raysare the most important method we have for investigating these cases, butcare is needed to avoid the numerous pitfalls in this very special method ofinvestigation. It is essential to examine the whole urinary tract, i.e. bothkidneys, ureters and bladder, for stones may be present on both sides withsymptoms only referred to one, and a stone low down the ureter may givethe same signs as one in the kidney. The bowels should be well cleared out to avoid the shadows thrownby opaque substances in the intestine. The patient lies on his back with RENAL CALCULI 525 two plates, twelve by ten inches, under the lumbar and sacral regionsrespectively ; the respiratory movements of the abdomen are restrained bybroad bandages attached to the couch or an air-cushion clamped downto the latter, and he is instructed to breathe with the thorax only.A soft tube is placed over the umbilicus and an expo

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