XITHOTOMY. 



Wlulc the operator is pafTinsr the forceps nlong the gorget, 

 the latter inllrumcnt muft be kept'quite niotior.lefs, lell its 

 fl\arp edge diould do mifchicf ; and as foon RS the forceps is 

 ill the bladder, the cutting gorget is alfo to be taken away. 

 Delineations of the fovceps, ufed in lilhotomv, will be 



forceps, the furgcon niould introduce his finger, in order to 

 feel whether any fragments lliil reniain bihind. If they 

 fliould do fo, his bell plan, provided they are very fmall, is 

 to injecl lukewarm WHter, with moderate force, thron^h the 

 wound into the bladder, for the purpole of wafliing them 

 found in the furgical plates of this work. We fhall only out. A fort of fcoop, ufiially contained in every cafe of 

 obferve, refpeAing this inftrument, that the operator fhould inllrnments for lithotomy, may fometimcs be ufcf\;l in ex- 

 'be provided with at lead three or four pairs of different fizes ; trading pieces of broken calculi. See the furgical plate?. 

 and that they are commonly made of too thick and clumfy Tie operator outjht always to examire a flone as foon a$ 

 a conftruftion, whereby they of themfelves almoll occupy it is cxtraded ; if its whole furface be rough, it is a pre- 

 the whole of the paflage through which the Hone is to be fumptlvc fign that there is no other calculus prefcnt ; if its 

 drawn. outfide (hould be fmcjoth on one fide and rough on the other. 



Our defcriotion has now advanced to that point of the it is not improbable that there are other (lones. But in 

 operation, when the (lafF and gorget have been withdrawn, every inflance, the furgeon fliould introduce his fore-linger, 

 leaving the forceps introduced. The next objeft is to get in order to obtai.i decifive information en this point ; for it 

 hold of the ftone with the forceps. In doing this, the fur- would be unpardonable to put the patient to bed while 



geon will do %veU to remember the judicious mode parfued 



by Chefelden, as detailed in our account of this gentleman's 



■improvements. He fliould not unmeaningly expand the in- 



Itrument, as foon as it is in the bladder ; neither flionld he 



another Rone remains in his bladder. 



Sometimes Hones cannot be grafped with the forceps, un- 

 lefs raiftrd by the index and middle finger of the left hand, 

 introduced into the reftum. Firll Lines of the Practice of 



awKwardly tlirull it about at random, without any deter- Surgery, p. J32 — Jjy. edit. ii. 

 minate fclieme. The moll advifable method at firft is not Of the oLjcaions to cutt'wg gorgets. — Mr. John Bell of 

 to open the forceps, but ufe the inilrunient as a kind of Edinburgh, in his Principles ot Surgery, vol. ii. has freely 

 probe, for afcertainlng the exaft fituation of the ftone. If delivered his fentiments on the daggers iiid difadvantages of 

 this body fliould be lodged at the lower part of the bladder, the cutting gorget, and as we think there is much reafon and 

 juft behind the neck of this vifcus, as is moftly the cafe, and truth in what he has faid, his obfervatiois appear to us well 

 be diftintily felt below tlie blades of the forceps, the operator worthy of the mofl ferious coiifideration. They tend to 

 is to open the inllrument immediately over the (tone, and, fliew that there i.s no method of performing lithotomy fo ex- 

 after depreffing the blades a little, is to fliut them, fo as to cellent as that with only a llaff and a fcalpej, and that if fur- 

 grafp it. Great care, however, ntuil be taken not to fhut geons would take the trouble to quahfy themk4vt-s tor this 

 the inllrument in any other than a gentle manner, as breaking laft mode of operating, a thing by no means diflicult, all 

 the Hone is an exceedingly unpleafant and troublefomc oc- cutting gorgets might be for ever laid aiide, to the great be- 

 currence. Chefelden, we are informed, ufed, when the nefit of mankind, and the real improvement of lurgery. 

 flone was found foft, to interpofe his finger between the Mr. John Bell reminds us that " thf i;oigc/J!ips .' and all the 

 blades of the forceps, in order to keep them from making furgeons of Europe confefs it ! it flips in the hands of the 

 too much prefTure. Certainly it is far more fcientific to ufe moil fliilful furgeons, and no one can be rtfponfible for the 

 the forceps at fir.1, merely to afccrtain the pofition of the coPifequences of a thrull fo defperate, and requiring fo 

 ftone; for, when this is known, the operator can much much force. It fl^ps fo frequently, and is avowciily fo liltle 

 more eafily grafp the extraneous body in a fl<iiful manr.cr, under the controul of the opera'.or, that 1.0 man ventures to 

 than if he were to open the blades of the inftrunient im- blame his brother for a misfortune which rrray happen in his 

 mediately, without knowing where they ought next to be own hand. So imperfedl is the inftrument, aiul fo dangerous 

 placed, or when fliut. No man can doubt, tiiat the injury this plunge, that to prevent the gorget being driven through 

 •which the bladder frequently fuffers, from reiterated and the fundus of the bladder, is a poiiit of fo much iinportaiici: 

 awkward movements of the forceps, has a conliderable fliare as to occupy, to this day, the genius of inventors, who have 

 in giving rife to fuch inflammation of the vifcus, as often thought to guard the edge by a double, or flipping gorget ! 

 fpreads to the peritoneum and bowels, and occafions death. and fo far is the incifion, after it is fafely made, from being 

 When the ftone is found to be fn large, that it cannot be adequate to the extraciion of the ftone, that the fize and 

 ■extracted without violence and laceration, the furgeon may form of the gorget, and efpeeially the expanfion of its 

 either break the ftone with a ftrong pair of forceps, con- blade, and the broadnefs of its cutting edge, varies every 



ftruCtcd with teeth for that purpole ; or by means of Mr. 

 H. Earle's inftrument ; or elfe he may enlarge the wound 

 with a common fcalpel, or a probe-pointed biltoury, intro- 

 duced under the guidance of the fore-iinger ul the left 

 band. 



day. The inftrument was once conica', but is now cylin- 

 drical ; it was once narrow, but is now broad ; it was once 

 double, with the beak in the centre ; it is now fingle, witii 

 the be.ik on one fidq ; when firft fliarpcned by fir Cifar 

 Hawkins, it was round, becaufe it had been im.mediately 



To the employment of the knife, in this circumftance, we before a mere dilator ; it is now flat, and entirely refcmbles 

 have to exurefs our decided preference. Breakino; the ftone a knife. 

 in the bladder fhould always be avoided, if pofliblc ; as it 

 creates fuch a chance of calculous fragments being le t be- 

 hind, and obliges the furgeon to diflurb and hurl the bladder 

 too much by the repeated introduftions of the forceps. 

 We wifti it, however, to be well underftood, that when the 



" It is not without reluctance, (proceeds Mr. John Bell,) 

 that I rank this among the inventions, where mechaniim is 

 fubllituted for fl;;ll. If this form of inftrument were iound 

 fafe in pr.iclice, I fhould be as little apt as any man to be 

 infeftcd by fpeculative fears ; but it is a murderous weapon ! 



ftone is excefiively large, and cannot be brought through as When the dafti is made with, the gorget, ei!hc?r It is at once 



free an opening as can be prudently made, without the em- fucccfsful, or, if wrong, is irretrievably fo ; for thoiigii in 



ployment of unwarrantable force, it is the duty of the operating w ith the knife, you can make a fecond ii cifion, 



operator to try to break it. in operating with the gorget, if you fail in the firft, you 



When this has been done, and as many of the broken can make no fecond plunge. The belt opeiators in this 



pieces have been taken out as can be ilifcovercd with the country, among whom I have no doubt I may reckon Mr. 



8 Earle, 



