Notes in practical surgery / by George H. Porter.

  • Porter, George Hornidge, 1822-1895.
Date:
1865
Catalogue details

Licence: Public Domain Mark

Credit: Notes in practical surgery / by George H. Porter. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    which dribbled away at night, and he was also annoyed by painful erections. When he came under my care all the foregoing symp- toms were prominently developed; and on examination it was found that he had a large bunch of external hemorrhoids, and that the glans penis, which was quite uncovered by prepuce, was looking moist and excoriated, and the lips and orifice of the urethra red and slightly everted. On the 21st September, with the assistance of my colleagues, I sounded him, being unable to pass a sound larger than No. 9, in consequence of the small size of his urethra, which was throughout narrow, though no abrupt stricture existed. The instrument on its introduction caused him a great amount of pain, but it immediately struck the calculus, giving proof of its j)resence. I withdrew the sound, and endeavoured to mciisure the stone with Mr. L’Estrange’s ingeniously-constructed lithometre, but I was dis- appointed, as I could not grasp it. The sensation, however, wliich was given from passing the instrument over the surface of the stone led to the impression that it was of considerable dimensions. Mis urine was acid, and contained some pus globules. It also became slightly clouded when heat was applied, but only to as great an extent as could be explained by the presence of the purulent matter. On the 1st October, having his rectum cleared by an enema, and himself placed under the influence of chloroform, I pro- ceeded to cut him for the stone. The man having been tied in the usual manner, 1 injected three ounces of tepid water into his bhulder, and a No. 9 staff, grooved on the side, having been intro- duced, and admirably held by the late Mr. Smyly, the patient’s buttocks were brought a little over the edge of the table. Kneeling then on my right knee, I commenced an incision with ^Ir. Fergus- son’s knife one inch and tlu-ce quarters in front of the anus, to the left of the raphe; this I carried down midway between the tuberosity of the ischium and the anus, fairly passing both. By so doing it will be evident that the length of the cut was considerable; and 1 deem it of great importance to make the first incision a free one; (nearly three inches in the adult). I then divided the deeper structures with one or two light strokes of the knife; and having felt for the groove of the staff with the forefinger of my left hand, the nail of which I firmly fixed in it, lowering my wrist I thrust the lateralized knife from the lowest part of the wound upwards, and lodged its point in the groove, transfixing the urethra at its membranous portion. 1 then steadily pushed on the knife along the groove into the bladder, dividing partially the triangular fascia.
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