Clinical lectures on diseases of the urinary organs : delivered at the University College Hospital / by Henry Thompson.

Sir Henry Thompson, 1st Baronet

Date:: 1868

Credit: Clinical lectures on diseases of the urinary organs : delivered at the University College Hospital / by Henry Thompson. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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$trouble and uncertainty to have gone close to it, which you always ought to do; never let it be a timid shallow cut, merely dividing the skin. The end of your index finger follows, and should feel the staff easily through the tissues. Fixing the finger-nail upon it, the point of the knife is placed firmly in the groove, and is run steadily on in contact with the staff. Keep the point up, and you will be safe; let it down, and you may slip out and get into the rectum, or nobody knows where. Simply go on, letting the blade be a little more horizontal as it proceeds. Go on till you are well into the bladder, not letting the point leave the staff. The depth of the incision will depend upon the angle which the knife makes with the staff: if you withdraw with the knife close to the staff, of course you will only make a wound the width of the knife; and if the edge is directed outwards and downwards against the soft parts, with a light hand, as you come out, you will make a freer and cleaner opening. It is better to be rather free in cutting than otherwise [the pre- sence of a large stone is assumed], but you must not make the incision too wide. There has been a great deal of good advice expended about this subject—the depth of the incision, but it is manifestly impossible for one man to make another understand what he means or what he does by any amount of talk. My belief is, however, that the result of our anxious care about this matter is, practically, that we are apt to cut rather too niggardly than too freely, and that the neck of the bladder, in consequence, receives severer injury from the stone and forceps than it otherwise would receive from the knife. This relates, of course, to adults; for in children you can scarcely find the prostate—it weighs but a . few grains, and does not come in for a moment's considera- tion, and your knife goes far beyond its limits; yet these \$