Surgery : its theory and practice / by William Johnson Walsham.
- William Walsham
- Date:
- 1897
Licence: Public Domain Mark
Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
734/898 page 718
![has entered the groove in the staff—], wounding the rectum, either from cutting too perpendicularly, or from not having had it cleared out by an enema; 2, wounding the artery of the bulb in conse- quence of beginning the incision too high, or directing the point of the knife subsequently too much upwards; and 3, missing the groove in the staff. ,13. On entering the bladder—1, letting the point of the knife slip out of the groove in the staff and enter the cellular tissue between the bladder and rectum; 2, cutting the pudic artery from holding the knife too much lateralized; 3, sending the point of the knife through the posterior wall of the bladder; 4, cutting the prostate too widely, and dividing its capsule, whereby the urine may be extravasated into the cellular tissue of the pelvis; 5, wounding the prostatic plexus of veins; 6, tearing the urethra across, and so pushing the bladder off the end of the staff, whilst trying to pass the finger into the bladder (this accident is due to not making the opening into the urethra large enough, and is most common in children in whom the tissues are readily lacerable); 7, making too small an incision in the prostate so that the parts are bruised or torn in removing the stone, and inflammation is set up; 8, seizing the walls of the bladder by the forceps. These dangers may be best avoided by observing the following rules—1, feel the stone with the staff before you begin the operation; 2, see that the rectum is empty, and make it contract by introducing the finger; 3, make the external incision free; 4, feel both edges of the groove in the staff with the finger, and place the point of the knife between them; 5, keep the point of the knife well pressed into the groove of the staff; 6, take care that the finger is pushed into the bladder in contact with the naked staff; 7, do not remove the staff till the finger touches the stone. The difficulties of the operation.—In adults the chief difficulty is to extract the stone; in children to get into the bladder. A. The difficulty in entering the bladder depends chiefly on—1, not making the opening into the urethra free enough, and so pushing the finger between the bladder and the rectum; 2, a deep perineum so that the finger cannot reach the bladder; in such case a blunt gorget must be substituted for the finger. B. The difficulties in extracting the stone are—1, the stone may be too large; 2, it may get behind the prostate; 3, it may be lodged in a pouch in the upper fundus; 4, it may be encysted; 5, it may break or crumble up ; 6, it may be so small that it slips from between the blades of the forceps; 7, there may be an enlargement of, or tumour in, the prostate, whereby the urethra is greatly lengthened; 8, there may be some rickety or other deformity of the pelvic bones. When the stone is behind the prostate, curved forceps, with the blades turned down, must be used; when the stone is above the pubes, the blades must be turned upwards, the handle depressed, and the stone pressed](https://iiif.wellcomecollection.org/image/b21514392_0734.jp2/full/800%2C/0/default.jpg)
