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V.- 
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\-f-r.-r 
SURGERY. 
Tiiese symptoms come on in fits. In order 
to ascertain the tact,- a solid steel instrument, 
shaped likea catheter, and called asound,is 
introduced into the bladder, where its point, 
meeting the stone, gives decided informa- 
tion to the surgeon. It must be moved in 
various directions after its introduction, as 
it may not immediately or easily come in 
contact with the stone. The operation 
.should never be perforuted, unless the stone 
can he plainly felt before the operation: 
the rectum should be previously emptied, 
but it is more advantageous for the bladder 
to be full. The patient is to be placed with 
liis pelvis at the edge of a table, and the 
sttiff introduced into the bladder. The 
thighs and legs are then bent so as to ena- 
ble him to grasp the soles of the feet with 
his hands, and the liml)s are retained in this 
position by broad garters, doubled and 
placed by means of a noose round the 
wrists, cariied over tlie back of the hand, 
and inside of tlie foot; then brought up 
again, and continued round the wrist and 
ankle and firmly tied. The staff is shaped 
like a sound or catheter, and has a groove 
for conducting a cutting instrumeiit into the 
bladder. An assistant standing on tlie pa- 
tient’s right side holds the handle of the 
staff with one hand, making its convexity 
project in the perineum, and draws aside 
tile scrotum with the otlier. An incision 
should be made through the integuments, 
commencing on tlie left side of the raphe 
of the perineum just opposite to the mem- 
branous part of the urethra, and continued 
obliquely downwards and outwards for 
about three inches between the anus and 
ischium. The transversalis perinei should 
tiien be cut through, and the membranous 
part of the urethra freely opened, so as to 
expose the groove of tlie staff. The beak 
of the gorget is now introduced into the 
groove, and the opevator takes the handle 
of the staff into his- left hand, holding the 
gorget in his right. He then thnists the 
gorget into the bladder, keeping its beak 
ill close contact with the groove of the 
staff’, and bringing the handle of the latter 
instrument downwards and forwards, in or- 
der to raise its point, and make its direc- 
tion coincide with the axis of the bladder. 
The cutting edge of the gorget, by this 
mode of introduction, divides the pros- 
tate gland and neck of the bladder. This 
instrument is used of various figur,es by 
diiferent surgeons. The best perhaps is 
that in wliich the cutting edge of the in- 
strument e.\tends horizontally from its beak, 
from which it may be carried to the length 
of three quarters of an inch. A good ana- 
tomist may perform the operation with a 
scalpel, which instrument will enable him 
to divide the parts with more exactness. 
Tlie escape of the urine shows that the, 
bladder is opened. The stalF should now 
be witlidrawn, and a proper pair of for- 
ceps passed along the concave surface of 
the gorget into the bladder, for the purpose 
of seizing and extracting the stone. Tliis 
instrument is first employed as a probe to 
ascertain the position of the stone, which 
being accomplished, the blades are to be 
expanded and moved in sucii a direction as 
to grasp it ; and the instrument very firmly 
held, may then be slowly withdrawn, be- 
ing moved from side to .side in order to 
bring the foreign body through the wound. 
If the stone be very large, it may be expedi- 
ent to dilate the wound with a curved knife, 
or to break the stone in the bladder by 
means of forceps constructed for that pur- 
pose. In the latter case, and in instances 
where the stone is broken in the operation 
of extracting it, the bladder should be 
washed out with lukewarm water to re- 
move any small fragments. Careful exa- 
mination with the finger is necessary to 
ascertain tliat nothing is left behind. A 
compress of lint, pledget, and T bandage, 
may be put on, but they are of little service, 
as the urine escapes through the wound. 
Since peritoneal inflammation is the occur- 
rence most to be, feared after lithotomy, 
great attention to the state of the abdomen 
is required, and on the least indication of 
such a consequence, venesection, leeches, 
warm bath, warm fomentations, blisters, 
emollient clysters, and purgatives,- should 
be rc.sorted to, according to the symptoms. 
This mode of performing lithotomy is 
called the lateral operation ; it has been 
performed with an instrument called a li- 
thotome cacli^, instead of the gorget. This 
is a long narrow knife, concealed in a groov- 
ed instrument, which is psissed into the 
bladder along the groove of the staff exposed 
in the way already described. A spring 
being then compressed makes the knife rise 
out of the groove, and the instrument is 
withdrawn in this state, cutting the pros- 
tate and biadder as it recedes. In former 
times an opening has been made into the 
bladder above the pubes, particularly the 
young subjects ; this was called the high 
operation, but has long been disused. 
iSfjiina hijiAa is a swelling situated on the 
spiue of infants at the lime of birth. It 
