File:The surgical diseases of the genito-urinary organs including syphilis (1889) (14758368516).jpg

Identifier: surgicaldiseases00keye (find matches)
Title: The surgical diseases of the genito-urinary organs including syphilis
Year: 1889 (1880s)
Authors: Keyes, E. L. (Edward Lawrence), 1843-1924
Subjects: Urology Syphilis
Publisher: New York : D. Appleton and Company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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ight hand, is in readiness to commence. Should thestaff fail to strike the stone, it may be withdrawn and the searcherintroduced. Should this also fail to detect it, after a careful and pro-longed sounding, the operation should be deferred. Some of the best 302 LITHOTOMY. operators have been deceived in their diagnosis, and have cut patientsin wliom no stone existed ; so that it has become a cardinal rule neverto cut a patient in whom the stone can not be felt after he is uponthe table. The sound may fail to detect it, if it lies in a deep ba.i-f0)1(1, but not so the searcher. The holder of the staff usually satisfies himself that the soundstrikes the stone. It is not essential that the end of the staff shouldrest against the stone. As long as it is certainly in the bladder, noth-ing more is required. The chief assistant stands at the patients left,holds the staff vertically, steadily, and firmly hooked up under thesymphysis, with its long curve a little bellied out in the median line
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Fio. 98 (T//o?npson). of the perinfeum, and keeps the integument of the latter taut by pull-ing the scrotum up around the staff. The assistants steady the knees,while the operator impresses his mind finally with the shape and sizeof the long outlet of the pelvis by running his fingers down the ramiof the ischium, touching their tuberosities, feeling the symphysis pubisand the coccyx. The surgeon should picture to himself a pelvis lyingbefore him, in position, denuded of soft parts (Fig. 98), and recallthe general inverted heart-shape of its outlet (Fig. 99). The operator now introduces the left index-finger into the rectum,assures himself that the sound enters at the apex of the prostate andpasses centrally through its canal, and that the rectum is empty andcollapsed. Then, withdrawing his finger, he searches, with the thumbor finger of his left hand upon the raphe of the perineum, for the THE OrERATION. 303 groove in the stafP, which, in a thin person, can always be obscurelyfelt. If

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