File:The surgical assistant, a manual for students, practitioners, hospital internes and nurses (1905) (14596900169).jpg

Identifier: surgicalassistan00bric (find matches)
Title: The surgical assistant, a manual for students, practitioners, hospital internes and nurses
Year: 1905 (1900s)
Authors: Brickner, Walter M. (Walter Max), 1875-1930
Subjects: Surgery, Operative
Publisher: New York, International journal of surgery co
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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g and accessory tables andthe disposition of the patient, the surgeon and the assistantare then just as described for perineal and vaginal opera-tions. Preparation of the Field. The perineum should beshaved. In order next to cleanse the rectum the assistant 277 278 The Surgical Assistant. may find it necessary to first stretch the sphincter ani topermit the introduction of the sponge. The patient must be well under the anesthetic, and will ordinarily groan dur-ing the dilating process unless the narcosis is profound. Thethumbs, anointed with soap or vaselin, and with their dorsalsurfaces apposed, are introduced into the rectum, as far as,or just beyond, the knuckles. With the other fingers, pur-chase may be secured on the buttocks. The thumbs are thendrawn slowly and steadily apart until the sphincter is felt to■ give and the anus gapes. This should be accomplishedwithout any laceration of the mucosa. After rectal opera-tions, more especially after operations involving dilatation of
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Fig. 101. Manner of stretching the sphincter ani. the sphincter, it is often the case that the patient is unable tovoid urine voluntarily for a day or more. This is particu-larly apt to occur if the stretching has been done in a verticaldirection, i. e., towards the urethra and towards the coccyx.It is wise, therefore, for the assistant to stretch only later-ally, i. e., to draw his thumbs towards the tubera ischii. The rectum is then swabbed out with soap and water bymeans of a sponge or cotton mop fastened in a spongecarrier. With the anus held open, the soapsuds are next Rectal Operations. 279 washed out of the bowel by an irrigation with warm subli-mate solution, 1-5000. Only a small amount of the solutionshould be used, for if any be retained in the gut it may beexpelled later during the operation, to the annoyance of theoperator. To prevent any such expulsion of retained fluidor of feces, and also for use as a tractor to expose internalhemorrhoids, there may be introduced into t

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