File:The science and art of surgery - being a treatise on surgical injuries, diseases, and operations (1878) (14759601976).jpg

Identifier: scienceartofsurg02eric (find matches)
Title: The science and art of surgery : being a treatise on surgical injuries, diseases, and operations
Year: 1878 (1870s)
Authors: Erichsen, John Eric, 1818-1896
Subjects: Surgical Procedures, Operative Surgery
Publisher: Philadelphia : H.C. Lea
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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ade sure that it is in the bladder, and having, ifpossible, felt the stone, he directs the assistant to withdraw the staff fromthe urethra. Here let us pause, and examine the principal points in these the firstand second stages of tiie operation. It will be observed that, in ac-cordance with the best authorities upon this subject, and with my ownexperience, I have recommended the external incision to be free, therectum to be protected by the left index-finger, the knife to be somewhatlateralised during and alter the opening of the urethra, and the deepincision to be limited. 1. The Position of the Knife must be carefully attended to, espe-cially during the deep or second incision. At this stage of the opera-tion the edge should be lateralised; that is, directed about midway Fig. 740.—Knife in Groove of Staff. MANNER OF HOLDING THE KNIFE, 41 liotvveen the horizontal and perpendicular positions, so that the snrfnceof the blade lies nearly parallel to the ramus of the ischium. The man-
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lliMNi!iiliiiiiii:iiiiuiiiiiiiiiiliillnmiiiniiiiuiiiiiiiiiiiiiiill«llllllliiiiiimiiiirFig. 741.—Second Stage of Lithotomy. ner of holding the knife has been much discussed, and necessarily andnaturally varies with different Surgeons. I lielieve it signifies little how the handle of the instrument is heldbetween the Surgeons fingers, pro-vided the edge be never turned ui)-wards, but be always kept well later-alised,and the point steadily pressedinto tlie gioove of the staff. Provided a Surgeon know whathe is about, he may safely hold hisknife as best suits his own conve-nience. In the first incision, mostoperators, I believe, hold the knifeunder the hand, as represented inFig. 143 ; a position which that ex-cellent lithotomist and accomplish-ed Surgeon, Fergusson, preservesthroughout the operation. Liston,in the earl)- part of his career, ap-pears to have held the knife, in thesecond stage of the operation, abovethe hand ; and in all the representa-tions, published as well as unpub-

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