LITHOTOMY. 



85 



prostate or sandy matter in the urethra. In case of difficulty in de- 

 tecting a stone, it is better to repeat the operation frequently, the 

 patient being placed in difftrent postures, than to prolong the ex- 

 ploration, at the risk of producing inflammation of the bladder. 

 Having detected the stone, it is possible to form some idea of the size 

 and number by sounding. Some have attempted the disintegration 

 of the stone by injecting various solutions into the bladder ; but the 

 most common operations are Lithotomy, Lithotrity, and Lithotripsy. 



LITHOTOMY. 



This is an ancient operation, modified and improved in modern 

 times. It is to be performed in children and in old persons, when 

 the stone consists of the oxalate of lime, and when there is stricture, 

 or diseased prostate. 



The different modes of performing the operation are the lateral, 

 high, and bilateral. The lateral is most common, and is performed 

 in this manner: 



The patient, having been properly prepared by emptying the 

 bowel and retaining the urine in the bladder, is placed upon a table 

 of convenient height, and firmly bandaged hand to foot, with his 

 knees elevated. A staff as large as the urethra will admit, and 

 deeply grooved on the convex and left side, is then introduced. Two 

 assistants separate the knees, so as to expose the perineum, which 

 ought to be cleanly shaved. The patient is then to be brought to 

 the edge of the table, and the surgeon seats himself in front with his 

 instruments in good order, and conveniently at hand. The staff, 

 being brought in contact with the stone, is well hooked up under the 

 symphysis pubis, and not pressed down upon the rectum, and then 

 given to a third assistant, who is directed to hold it vertically, and 

 also charged with keeping the scrotum out of the way. 



Fig. 24. 



