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.

    605/630 page 575
    Oi O some measure, be overcome: but still the extracting force must be ap- plied graduallyi and in a direction more towards the door than the surgeon, and thus the expansion will be chiefly in that direction in which the space between the bones is largest. I believe that it is ot some consequence, also, to have the whole forceps of considerable length, (from nine to ten inches for the adult,) as the lever torce may be of great importance when the stone is very large ; and »> al instances it is wise to have at hand a variety of forceps of difleren sizes, for occasionally a stone proves to be much larger than has been anticipated, and a full-sized instrument may then bo of great service. The concavity of the jaws of the forceps is usually made rough, having a variety of little metallic projections; but some prefer those lined with stout linen, which is sewed to them through apertures made on purpose, as may be seen in the drawing on a preceding page. Sometimes it may be advantageous to have the forceps curved near the points, so as to reach the lower part of the bladder more conveni- ently, or perhaps up behind the pubes, and in certain instances, such as when the stone is flat and dilhcult to seize, a scoop (tig. ’246) may Fid. 24ti. aas&l- bc more serviceable than the forceps. This instrument is used by passing it behind the stone, then fixing the latter against it with the point of the left forefinger, mid thus extracting all three at the same time. ... , The principal dangers in the operation above described are, wound of the rectum or of some large blood-vessel. The former will lx- best avoided by keeping the knife, when in the deep jiart of the wound, chiefly nb’ove the finger, which may also be used to depress the gut. Under the age of puberty there is seldom any annoyance from hemor- rhage, but in the adult there may lx» both trouble and danger. The superficial perineal artery, or its transverse branch, is occasionally of such size, that, when divided, a ligature may be necessary it is usually so near the margin of the wound that it can be secured with great facility. The artery of the bulb will seldom lx> cut, as the point of the knife* should never be carried so high at this part: an anoma- lous branch (forming the dorsal artery of the penis) occasionally tra- verses the line of incision in the prostate, but such a circumstance is rarely met with, and when the scalpel is used (for it may be per- ceived that there is little difference between the blade represented at p. 5liU and the last-named instrument, saving that the one for litho- tomy is blunt towards the heel), the edge of the knife is not likely to encounter the common pudic. Perhaps the most troublesome hemor- rhage may be from the veins around the neck of the bladder, which in
    No text description is available for this image
    No text description is available for this image
    No text description is available for this image