The surgical treatment of the diseases of infancy and childhood / by T. Holmes.

  • Timothy Holmes
Date:
1868
Catalogue details

Licence: Public Domain Mark

Credit: The surgical treatment of the diseases of infancy and childhood / by T. Holmes. Source: Wellcome Collection.

    647/700 page 599
    child's legs up, since they can be held with perfect ease, and the position can be varied according to the fancy of the ope- rator. If the legs are tied up, there is often a little trouble in passing the staff, while if the staff be passed first, time is lost, and the instrument may again slip out of the bladder; so that I never use any garters or shackles in children's lithotomy. The stone should be felt with the staff, and if possible heard, before the operation is proceeded with. If the stone cannot be so detected, the proceeding should be delayed till another day; and this for two reasons, viz. either there is no stone in the bladder, the conclusion from the pre- vious sounding having been erroneous, or the stone having subsequently been passed unperceived, or the staff is not in the bladder, and therefore cannot strike the stone. Instances are not wanting in which this latter accident has occurred on the operating-table itself. The operator has passed the staff and struck the stone, and then in replacing it when it has accidentally slipped out, or in passing a different instrument, the point has pierced the urethra and lodged between the bladder and rectum.* To cut upon a staff thus misplaced leads inevitably to what is, as we shall presently see, the most dangerous and embarrassing error in lithotomy. The staff being now in contact with the stone, and the child held securely in the proper position, i. e. with the knees flexed to the extreme, widely separated and quite even with each other, the operator seats himself before the table. The staff is to be held by the assistant perfectly steady, and in the position best suited to the taste of the surgeon. Some like the staff pulled up so as to be hooked under the pubes, in order to guard against its slipping out of the bladder; others like it somewhat depressed and turned to the patient's * It may not be out of place here to insist upon the great gentleness which ought to be used in passing instruments, especially metal ones, in children. A very little force is required to produce false passage. I think this is less liable to occur if the child is under the influence of chloroform. Many surgeons (as Mr. Cooper Forster) tell us that narcotism renders the formation of a false passage more probable, since the child cannot indicate when he is hurt. I think exactly the contrary. A child is sure to be hurt by having an instrument passed, though no false passage be made. He will then put all his muscles in violent action ; and now, very probably, an instrument cannot be passed without an amount of force exceedingly liable to produce false passage. On every ground I prefer to pass an instrument, if possible, under chloroform.
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