File:The surgical diseases of the genito-urinary organs including syphilis (1889) (14758377226).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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be forgotten that the rectum has been lacerated bjoverdistention of the colpeurynter, and the bladder ruptured in thehands of most competent surgeons (Monod, Cheselden, Verneuil), andan error should be made, if any, on the side of safety. Now a central incision about three inches long is made in themiddle line, terminating at the pubic symphysis. The superficial fas-cia is cut through with the skin, the deep fascia more carefully. Thesulcus between the recti muscles is sought, but, if not easily found, acentral incision is made cleanly through the muscle parallel to itsfibers. No separation of the muscles should be made except what isabsolutely necessary, for such separations favor the possibility of subse-quent infiltration. Particularly is it desirable not to poke about withthe fingers or instruments in the prevesical space behind the symphy-sis. This is the most dangerous area after the operation, the one inwhich pus is most likely to form and be a source of possible compli-cation.
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Fig. 103. 314 SUPRAPUBIC LITHOTOMY. After getting fairly through the muscles, a thin fascia is observedwith yellow fat beneath it. This fascia is freely tlivitled in the middleline, then the pulp of the finger is placed between the yellow layerof fat and the symphysis, and the fat is rolled upward toward theupper angle of the incision. This layer of yellow fat contains theporitonanim. Guyons niancBuvre of rolling it up is admirable. I havepracticed it a number of times, and I have never seen the peritonasumin any operation when I have done the cutting, cxccjjt in two in-stances in which the bladder was cancerous and the i)eritona?um ad-herent. If the peritoneum is opened it is not an important accident. Thewound is antiseptically washed and sutured with tine catgut, beingkept out of the way in the upper angle of the incision during the re-mainder of the operation. After the yellow fat has been rolled up the bladder is exposed, oftencovered with distended veins. With short-curved needl

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