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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    those advanced in years are often of considerable size. If necessary, the opening in the skin might be enlarged, to permit the application of a ligature to a deep-seated artery—it might even be possible to carry a curved needle round the pudic, were this deemed advisable ; but in the generality of instances the bleeding ceases as soon as the’ patient’s thighs are placed together; for then the cut surfaces come more closely into apposition : cold over the pubes may be resorted to; but the most efficient means of all—especially when a ligature cannot be applied—is to use the tube delineated at p. 5/1, which, when in- troduced into the bladder, can be so surrounded by plugs of lint as to keep up very efficient pressure, and at the same time the urine is allowed to dribble away through the canal. When the tube and plugs are withdrawn, at the end of four-and-twenty or eight-and-forty hours, the effused lymph on the cut surfaces will have closed the divided vessels. As the urine must escape by the wound for the next ten or fifteen days, a piece of Macintosh cloth must be laid between the patient and the mattress ; a folded blanket or sheet should also be placed under his breech, a sponge may be put in front of the wound, to absorb part of the urine, and care should be taken to keep the skin as dry as possible. Usually, from the swelling of the parts in the track of the incision, the urine passes freely by the urethra on the se- cond or third day, but it soon again all escapes by the wound, and then on the eighth, ninth, or tenth, it flows in part by the natural course, and in a few days more is entirely evacuated through this channel. The aperture in the perineum generally closes in about three weeks or a month, sometimes earlier, and occasionally much later, a few drops of urine coming from time to time, for six weeks or more, through a small chink still unclosed. The treatment after lithotomy, as regards diet, the state of the bowels, and the various evil consequences of the proceeding not parti- cularly referred to above—such as infiltration, wound of the rectum, inflammation of the neck of the bladder or of the peritoneum, &c., <Scc., should be conducted on the ordinary principles of surgery, which, it is presumed, must be known to any one who would undertake the ope- ration. Very recently a proposal has been made by Dr. Willis to extract the stone by dilating the neck of the bladder, after making an incision in the perineum and opening the membranous portion of the urethra, in imitation of an operation once performed by Sir Astley Cooper, at the suggestion of the Drs. Amott, and partly also of the old method of Romanus and Marianus by the apparatus major ; but it remains to be proved in how far the operation is to be preferred to the present method. A most intelligent friend, Mr. Thomas Elliot,, of Carlisle, has favoured me with an account of a case, in which he has successfully extracted a stone in this manner on a young man of seventeen, but as it is his intention to publish the particulars, and as the reader will do well to peruse Dr. Willis’s own remarks on his proposal (Lithectasy he
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