A system of practical surgery / [Sir William Fergusson].

  • William Fergusson
Date:
1842
Catalogue details

Licence: Public Domain Mark

Credit: A system of practical surgery / [Sir William Fergusson]. Source: Wellcome Collection.

    595/630 page 565
    5t>5 becomes comparatively empty, from the escape of urine through the chinks and alongside of the instrument, and then as the blades arc more likely to inflict injury, they should be closed and withdrawn. It will seldom happen that there is not some slight effusion of blood, the urine being generally tinged red for some time after, and clots occasionally pass away, either by themselves, or mingled with sand and small fragments. For the purpose of clearing the bladder as rapidly as possible, Heurteloup used an instrument of steel resembling a common catheter, through which, when introduced after the operation of breaking the stone, he injected tepid water until it was forcibly expelled, when clots, sand, and small fragments occasionally escaped at the same time through the eyes, which were purposely made very open. In case of any large fragment sticking in these apertures, a most ingenious stilet, constructed towards the point like a watch- chain, was introduced so as to cut them off, and allow the instrument to be withdrawn without injury to the urethra from any portion pro- jecting through one or other of these openings. The double-current catheter, with Read’s syringe, already referred to (p. 559), I have used with similar objects, and an elastic piece of steel has acted as a stilet. The subsequent treatment must be conducted on ordinary surgical principles. Usually when the stone has been divided, a smaller instrument than that which has originally been used will suffice for the fragments, which are on some occasions so very friable that the mere squeezing of the blades together with the fingers will suffice to crush them. The teeth may vary considerably in shape from those represented in tig. 231 : the two blades may be so made that the one encloses the other, or they may be opposed, as is re- presented in this cut (fig. 234). The instrument now most gene- rally in use is open on the convexity of that part between the turn and the point, so that the fragments cannot collect and clog up the blades in such a manner as to prevent them from being readily shut; but sometimes a kind of scoop is used—one blade having a large excavation. the other forming a sort of lid for it. Some of these are so constructed as to suit for catheters at the same time. In one instance such a curve as that represented in the sketches referred to may be found to answer best, in another the angle may be more or less oblique. In some in- struments the point beyond the curve is longer, in others shorter, as here exhibited (fig. 235);—but the minute details of these matters would carry me far beyond my present limits. Occasionally both patient and surgeon experience more annoyance from a fragment lodging in the urethra than from any other circum-
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