Outlines of surgery : being an epitome of the lectures on the principles and practice of surgery / delivered at St. Thomas's Hospital by F. Le Gros Clark.

Frederick le Gros Clark

Date:: 1863

Credit: Outlines of surgery : being an epitome of the lectures on the principles and practice of surgery / delivered at St. Thomas's Hospital by F. Le Gros Clark. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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$this position; but they must have been sufficient1 large, in the first instance, to resist expulsion. Be tention of the water may, however, be the climax c this gradual blocking of the passage; and it ma occur at any part, between the prostate and urethn orifice: the latter position is not uncommon, o. account of the contraction at the mouth of th< urethra. In the treatment of these cases, the stone must be removed, if within reach, either by dilatim- or incising the lips of the urethra, and seizing th foreign body with a pair of delicate forceps, or by hooking it out with a strong, bent probe. If in the perineum the stone should be at once removed from thence by incision. But if under cover, or in front, of the scrotum, it should be dislodged and pushed backwards, so that it may be cut out of the perineum ; or else pressed forwards to the orifice of the urethra. In permanent and spasmodic stricture, causing re- tention, the history of the patient is generally suffi- cient to determine the character of the obstruction, which is confirmed by an attempt to pass a catheter (p. 155). Perineal abscess, and extravasation of urine, are characterised by unmistakeable signs, as well as indi- cated by their history. In the former, the tense, and acutely tender swelling behind the scrotum ; in the latter, the rapid filling and speedily fatal inflam- mation of the lax areolar tissue of the scrotum, from the sudden and destructive irruption of the urine, and its spreading devastation around, leave but little excuse for an erroneous diagnosis (p. 157). Laceration of the urethra may result from vio- lence offered to its interior ; but, when it causes retention of urine, the injury is usually external, and accompanied by extravasation of blood or of urine into the perineum. The urethra is rarely torn completely across; but such an injury may be a con- sequence of fracture of the pubic portion of the pelvis. The diagnosis of these cases is usually un-$