File:The science and art of surgery - being a treatise on surgical injuries, diseases, and operations (1878) (14780260334).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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more parti-cularly if the extraction of the stonehave been tedious and deficient, thebladder being much manipulated. 3. Lithotrity in the female re-quires to be practised on the sameprinciples as in the male. The de-tails of the operation differ, however,in some important particulars. Thechief obstacle in the performance ofthe operation in the female, consistsin the difficulty with which the blad-der retains urine or water that isinjected into it. In consequence ofthis there is not only great diflScultyin seizing the stone, the bladder col-lapsing and falling into folds aroundit, but also danger of injuring themucous membrane with the litho-trite. In order to cause the bladderto retain the necessary quantity ofurine, the pelvis must be well tiltedup, and the urethra compressedagainst the lithotrite. It is well notto dilate the urethra before the in-troduction of the instrument, as the incontinence is thereby increased.The ordinary male lithotrite is not a very convenient instrument to
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Fig. 783.—Crusher for large Calculus inFemale Bladder. MALFORMATIONS OF THE BLADDER. 803 use in the female bladder, the handle being awkwardly long. This isespecially the case in female children. Hence I have found it convenientto have a shorter instrument constructed, with which it is far more easyto manipulate in the female bladder. If urine or water cannot be re-tained, the calculus may more safely be seized and crushed by means ofa small and strong-bladed pair of lithotomy-forceps : or, if the stone belarge, by a crushing instrument, made of the shape of that depicted inFig. 783. In performing litliolrity in tlie female it is not necessary topulverise the calculus, but merely to break it up into fragments of sucha size as to admit of easy extraction through the urethra. After the stone has been broken up, tlie urethra (unless this have pre-viously been done) may be dilated by means of the two-bladed instru-ment to a moderate degree, the larger fragments removed by means ofa pair

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