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.

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    tient is on the operating table. The Fig. 243. staff usually permits him to do so ; but as it is not of a convenient shape for making a minute survey of the bladder, should that be re- quired, it will be necessary to with- draw it, and pass a common short curved sound, which will probably be most conveniently used when the patient lies in the ordinary position for this process. In general the staff suffices for all the sounding which may be required at this par- ticular time ; therefore it is unneces- sary to pass the regular sound at first; but as the former may possi- bly not suffice, and as it is possible also that the stone may not be de- tected even with the most careful examination, and as consequently the surgeon would not be justified in proceeding further, it is always best in my opinion to pass the staff before tying up the patient. This latter circumstance may to some appear of less consequence than I seem to attach to it,—indeed, in my own practice I have not always attended to it; but the staff is not in even instance introduced so rea- dily as may be imagined ; and in case of difficulty, as it might be sup- posed that the attitude of the patient when his hands and feet are tied together might be unfavourable,—as I believe it is in some,— the sur- geon might regret having him thus bound ;—besides, there is nothing more likely to rutile the temper of a young operator than meeting un- expectedly a difficulty in this the beginning, and perhaps most simple step in the proceeding, and therefore he should avoid throwing an- noyance in his own way, however petty it may appear to those fami- liar with such matters. Before commencing the incisions, the operator should satisfy himself that the point of the staff has not slipped out of the bladder, which it is apt to do unless the assistant who holds it is careful; and when as- sured on this subject, he should place it in the attitude in which he wishes it held afterwards, and then give it finally in charge to the as- sistant. It has been the custom with some to cause the convexity of the instrument to project in the left side of the perineum, but this seems unnecessary. The length of the external incision in the adult should be about three inches; but if the patient is fat, the perineum deep, and the stone large, it should be made longer,—at both ends, but more espe- cially in front. It has been a customary recommendation to have the external wound as far behind the anus as in front, but I believe that the lower part of the incision is seldom of much advantage, unless, in-
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