SURGERY. 219 



13. Fractures. 



These occur in all the individual bones, although more rarely in some 

 than in others. 



In treating fractures, a point especially to be attended to is the trans- 

 portation of the patient, especially if the distance be considerable. In the 

 treatment proper, the first step consists in properly approximating the 

 fractured extremities, and then in keeping them undisturbed in close con- 

 tact; the rest must be left mainly to the recuperative energies of the 

 system. PL 14:0, ßg. 91, represents a bed well adapted for the ease and 

 immobility of the patient while under treatment for the union of a broken 

 limb. 



14. Calculus. 



Calculus, or stone in the bladder, is a very painful disease of frequent 

 occurrence. Owing to the danger of a direct operation for this disease, 

 efforts have frequently been made to discover methods by means of which 

 such operation might be avoided. The great objection to these methods, 

 known under the general name of lithontripsj/, is, that they do not act 

 directly upon the calculus, and that their long continued use, which is 

 usually necessary, introduces a train of new evils. 



We cannot pretend to enter into even a brief account of the various 

 methods of performing operations of litliotomy, or extracting the calculus 

 directly, as this would of itself require a volume. We must confine our- 

 selves to a reference to some forms of apparatus, by which the stone may 

 frequently be broken up in the bladder and evacuated in minute fragments. 

 The instrument invented by Civiale, and called Uthotriptor, has been made 

 use of with considerable success, although liable to the danger of lacerating 

 the coats of the bladder, and of bruising the parts about the neck. It is 

 represented in pi. 140, figs. 81 — 83, and consists essentially of a straight 

 cylindrical canula introduced into the bladder, and containing three or 

 four branches which can be protruded by external machinery. These are 

 then made to grasp the stone and hold it tightly, whilst it is bored, scooped, 

 and excavated by drills contained in the centre and worked by a bow. 

 When the stone is sufficiently excavated, its shell is crushed into small 

 pieces. 



The instrument most used at the present day is the screw lithotrite, com- 

 posed of two sliding blades, between which the stone is seized and crushed 

 by gradual pressure with a screw. 



925 



