1000000031

660

y ,

ealherer, ",hieh b, ióg pliable will prevent any painfu l mo·

tion of lhe inltrument in lhe

bladrler.

Tbe bladdcr being blled, an affillant, in order ro prevent

the reflux of the water, mufl grJfp lhe

ptlJiJ

the moment

lhe c¡theter is withdrawo.

holding

on one Cide, in fuch a

manner as nal 10 flretch lhe íkjn of lhe

abdo1J/en;

thea

Wilh 2

round eJ&cd knife make an ¡ncilion

allOU t

fOUT

iach–

.es long, be\wccu

lhe

rdli

and pyramidal

murcIes,

through

tbe

maJJvranQ oJipofa,

as deep as lhe

bl.ddeF,

bringing

ilS

extremity almaHdown

tothept'lJiJj

aher this, uking a craok.–

ed knire, continae

lhe

¡nci(ion

ioto lhe bladder,

carrying

a tiB ie

under the

(JJ

pubiJ,

and in1:'llediately

upon lhe \Va–

ter's flowing out, introduce {he

rore-finger

of your lefe hand,

which \ViII direél rhe forccps ro the 11. nc.

This method \Vas at

firll:

recei\'ed with great applaufe in

L ondon; but Ifl« fome trial \Vas rejeéled, for rho following

i!lconv:niences.

fom.:!Iimes happeos lhat the blad¿ér, ootwiththnding

the iojetlion,

Ilill

conlinues fo deepunder thf

pubÍJ,

lhat

lhe

p(ri:OI!/fUIIi

being necclfarily wounded firfi, che iate–

ilines pu/h

OUt

immediatdyat cbe: oribee, and the urine af–

lerwards empties ¡mo the

abdollletl ;

in whlch cafe. hardly

BOy

recoyer, Toe iRjeélion ¡lrelf is exceedingly painful;

and howeycr 'lIowly rhe fluid 'be injefled, il dillend. Ihe

bl,dder fo mlleh more fuddeody thao Ihe urioe from Ihe kid·

Ileys doe.s, and fa much (aller than it can well bear, that

nor only i. feldom dilated

eoo~gh

ro m,ke the operation abo

foluIcly Cecure, bUI is Cometimes e.ven burfi, or

Ic¡¡fl its

rone deflroyed by the

ha~y

dilaration. What adds ro Ihe

danger here, is lhe polJibility of meeting with a contra{ted

indurated bladder; which is a circuR"'aflilDce rometimes attend–

ing

011

lhe (lone, and iodeed an exceediAgly dangcrous one

in al! Ihe orher merhod.; but would be fnghtful in Ihis, by

reafl.ln

not only of the neceOity of woundiogthe

p!rllon~um,

bur of rhe diffieulry of comiog at the 1I0ne. If Ihe 110ne

be very fmall, it

hud ro lay hold of it \Vilh rhe foreeps,

and in a fat man the fingers are not loog

enoug~

for Ihat

purpofe, If rhere are maoy litrle llones, it will fcarce hap.

peo that more than one at a (ime Celn be: extraéled : aod ir

t»e none breaks, it not ooly ¡s impratlicable

take it aH

away in

~he

operation, but alfo, from the fupine porture of

•he patient, it will

generally

renlaio in the bladder ; where:–

as, iD the other methods. for the

0100:

pUl, it ",orles itfe!f

Oftt with

~he

urioe, But even fuppofing [hat the opetiltion

irfelf is profperou. , rhe confequeoces gene..

lly

are ycry

Irouble[ome ; for lhe urine:

Iffuing

out al an orífice where

¡here is no defctnl, fp reads il(df upon the

abd,)1/Ien,

and makcs v:.. ry paioful excoriations; tbough. whal1.s filll

worfe. it Comt:times io(inoates ittelf iota Ihe cells between

¡he bladder and

abdfJ1/Iinal

mufcles, and, tOgether wnh Ihe

inAammation 'excites by lhe operation. brings

0 0

a fuppura–

tioo there, which is always difficult to O'1.mage, and fre_

~ueorly

morr.1.

Of ¡he

LA TERAL OPERATIOH .

TH lS

mechod \Vas invented

an eccleGanic, who callecl

himfclf

Frc"

JdqueJ.

He came to Paris 'o Ihe year 1697 ,

bringing wnh lllm

ílO

abund.nce of certific.ues of his dex_

t.erity

op::niog j and making his hiltory koown to the

coun , and magifira,cs of lhe cílY, he got ",o arder tO CUt

at lhe

Ho/el

D ieu,

and the

Charilé,

where he performed

lhis operarion 00 . oour fifly perfon., H is fuccefs did not

aorlVer Ihe p,cmifes he h.d

m~pe,

TOe principal d,feér in his mann" of eutting wa, rhe

want of a groo\'e in hls

(};'(f:

whlch made ir diflicult to car·

ry the knife C'xaélly lotO Ihe bladder ; nor did he

t.~

¡ny

caTe

his patients alter the: oper ..lioD

fo th;l.t for wal'it of

propcr dreflings, lome of the wounds provc.d fifiulous, and

othl:r il!

eonfequeoc(~

enfued.

ChefelJen, lmproving Frere Jacquer's method, made

ure:

the

following, which

IS DO\V

the praélict of mofi operators:

The: p<llicot bClllg laid on a table, with his hand, and

feel tied, and Ih< lI,íF palf, d as in the olJ

W3)',

ler your

affiA:aot hold

Jiule flJnllng

0 0

one

fi\JC',

fa that

trH~

di..

retllOn of il may run eXoélly rhrough rhe mlddle of the left

ereflor

p~lI¡'

and

aCCf/uolor

urinil

murcies; then make your

iocifion th rour,h the fk,n and fal, very I"rge, ·beginoing oa

one lide of the Ceif;m in

"er¡'i~D,

linle aboYe the place

wouodcd

the old way, and h01fbingl Jiule bdow the anus,

betwet:n it and lhe tuberoGty

Ihe i:chium: this wound

mutl be carried

dc:eper belwecA the mufcles, until the

pro(tate be fdl¡ WhCD,

fear~hing

for the

Il ..

ff,

and 6xing it

properly, if ir h., IIlpr, you mull rum rhe edge of rhe

knife upw>rJs, aud CUI rhe whole I:nglh of rhar glaod from

within outwards, at the filme time pulhing dOIA:n the redum

",ith a fing::r or t\Vo of the left hacd¡ by which'precautions

lhe

gUI

wilJ

:...Iwóly

efcape wouncioJ!¡ alter WhlCh, the ope–

n lion 6nifhes Deady in lhe {ame m.lnDCr a!i. ",ith the gre¡¡tec

apparatus"

If,

upon introducíoS; tb e forceps, y,ou do not perceive the

llone readily, you mullltft up rheir handle, and fcel almoll

perpeodicularly for it

Cinee fol' the 'mon part, wlieo it is

hard to

caOle

al, it líes in one or the Gnufes fometimes forAl–

ed 00 eaeh fide of rhe ncck of Ihe bladder, wbich projeét

forward in (uch '" manner, that if ¡he Clone lie there. the

forceps pafs beyond ir Ihe ' momenr rhey are rhrough the

wouod: fo rhar il would be impofliblc to lay hold of ir, or

even tO (eel it, if not aware of dus circum(hmce.

When lhe Hene breaks, it is much (afer to totke away the

fragments with the forceps, chan to leave them he difchar–

ged

wít~l

the urine¡ and if the pie.ces are veJy fmall, like

fud, a fcoop i.s tbe befi inOrumentj tbough fome prefer the

injd ting barley.water into Ihe bl.dder, which fuddenly re–

turning. brings a\Va)' the broken

partides

of the (l ooe .

As thert> are hardiy ¡ny inltanct.·s of more (lones thw ene,

when the none taken away is rougb ; [o when it is rmooth

and poJiflled in any parr of it. it is almon a cenain fign of

others bc:hind; on which account,

i D

operator (hopld be:

careful, io ,har cafe, (OeJt:amine

nOl

ooly Wilh

hi~

finger!,

but fome conveoiem ¡nnrument, for the: remaioing ones ;

though inJeed, in all cafes.

may be propcr to examioe

lhe bladder after {he ext rallioo of a Clone; becaufe it

poffible rhere mar be • fccond 1100<, nOlwilhllanding tbe

6r11 be rough .

The: Rreat inconvenience of che 1.ueral operation

i!i

the

hremorrhAge which

fome times

eofuei' in meo; (or in cbildren

the

d~nger

of it is not worth mentionlOg,

in the operatioo aoy very b rge velfd

the external

wound fhould be: divided,

advlrc~ble

tic it befare: the

extr~ét;on

of the none ; but the neceffity of doing lhis, does

not occur once in twenty

tim~s,

T here is bUl one objeélion more

any conCeque:nce,

which is the nJuger

wounding the rtllum; and-this

is a vt!ry troublefome accident : But Ir the operator obfervtS

the

' 111~

bid down wÍth rcgard

that artide, it migbt al·

\v'ys oe

aYoide'~,

l a.