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s u G E R Y.
O, A (blf (j! for ,he o?erllion on boys from eighl !o
{oun een Y("iH S of :\ge~ The {!:tfF for a mao muH be: of lhe
liu o( rhe fOl1,d al« ady defenbed .
C. A !lall" fomCl hinn tOO biS (or ,he Cmalle'l ehildrcn,
bu, mal' be u:c:J upon boys (rom .bout four yezrs o( .se !o
t ight.
T he ntlfF has a groove on in (om"ex fid c: , which firft
fcrves ¡:¡s;¡ direttion wherc: tO CUt. and arterwards recciving
otile: be::tk o( [he COTter, guidt:, it readily to the: bladder.
eMe n\9u1d be t3k1!01, in mak:ng the groovc, thar (he edgc:s
-ef H be rmoothcd down, fo thílt [hey cannOl wound in par.
fi n:; tllrough rhe urelhra . The c:xtremity fllould alfo be o·
peo; othtrwire it will bt! romc:times diffi cuh l O withdraw the
lh-df. when lhe: gorg~t is introduced¡ :md prcfl~s againfl:the
er.d of it.
Thefe in(trumc:nts are: u[uaJly made with a ~reater bending
than hcre reprc:rc:ntc:d; bUl this (llape is more like tO that of
the urethra, aod rath~r mor~ IdvantageO\lS foc makieg the
iDcifioo.
D, lhe yake, 30 innrument tO be worn by meo ...,ith ao
incon'ioence af urine. h ¡s made with iran, bUI for ure
muO be covered with velvet. It moves upon a joint at one
cnd, aod ¡s f:dlcned al lhe other by c:uches al dlfT-!rent di –
llan'ces placed 00 a fpring o Ir muf1: be accommodated la
the Lize o( lhe penis, aoo -be taken offwhanever lhe patient
fiods an inclint1.tion 10 make watero This 'ina rument is ex–
ceedingly ufeful, becaufe it alw3ys an(wers the purpofe, and
fddom g. lIs ,he par! after. f<w weHing.
EX PLANA"roN ofFig. 5. PI. .. CLVII.
A, A fmall catheter mane of filver. This infirument is
hollow, and fervcs to draw,off lhe urine wheo under a fup ..
prdlion . 1, is alfo ufed in !he high operalioo !O fillr he bl.d·
der with water. Nearits ext remity. are tWO orífices, through
w';ich lhe water palI'es ioto its cavity. Care lhould be takeo
Ih.! ,he edges of th:fe otificcs are qui,e fmoo,h .
B, The kniCe ufed in cuuing for the llone: it is lhe fame
al ready drfcribed; bUI it is not improper to repeat the 6gure
with the ah ention o ( a quanlily o( tOW twiHed rouad it,
wbich makes it eafier tO hold, wben we per(orm the lateral
operation, and tUro the edge upwards to wound the pro(hte
gland .
e, A re.malecatheter, di ff~ring rrom the'male'catheter, it
bein!: almofi Itr2ight ; and fom~tbing Jarger. ,
V, A filver-wire tO pafs ioto cither c:uherer, for lhe re·
rnovir.g any grumoas blood or mauer that clogs Ihem up.
E XrLANAT rON of Fig. 6 . Pla!e CLVII.
A , T he g'>rget ufed upon men in lhe lateral operation .
B, T he gorgel uCtd upon childrcD onder 6ve years of age
in the !.tecra l operation.
A gorger be"veen the fizes of !hefe !wo will be li! for
boys (rom five years o( ,,&e tO fi(teen or {ixteen.
Thef. inltru",enlS are hollow for ,he palfage o( !h< foro
ccps into Ih!! bladderj :lod their handles lie Oanting, that
they mAy (he more readily be carrried through lhe wound of
the prorl4te, whichis made o.bliquely 00 {he lert fide of il.
The b, ak at ,he extremi!y of !he gorge' muft be fm. ller
than :he groovc or lhe naff which is cut upon, becaufe ir is
to he received in the grooveo Care lhould be taken, that
1he edges of the gorget Ilear the beak are nOI lharp, lean, in–
.{!e.d of dil..inS ,he wound, as i! ough!, i, lhould ooly eUI
011 e. eh fide ",heo inrrodu«d; in which cafe, il would be
ddfi cult tO C.Hry thlt furce¡>s IIItO, th.! bladder.
C. A ¡:orget. wrth its ha'ldle exzftJy ID the mid He; Ibis
O" ped inllrumeo, IS ured in ,he old ",ay. AH 'he gor&ell
lhould b! rmdc of 11«1.
EXrL ANAT rOH o( F,S' 7. P iare CLVII.
A. T he foreep. for rhe Oone. Thefe are re–
J'refented a liule open, tholl [he: h:eth m..y be belttr leen
within-fide .
This infl ru mcnt mafi be o( diffaent fizes'for differ~nt
ages and {tones . (rl/m th~ Jength of fuur inches to one of
near a (lJOI long ; bUI ,he for:':t'rs o( about eighe ¡Dches long
will he ·(ound moll generAlly uf.Jul. The Dumber
lO be (urnifhcd wi¡h, wlll be four Or 6'1e.
Great 'cart' fhould be t;(ken by lhe makers of (bis inOra..
Iftent, tb:.u II move carily upon Ihe rivet ; ..thal the extremity
of the chOflS do 110 r. meet ""hen they art (hut; and particularly
that {he teeth be not tOO large, len, io eotenng deep iDIO
,he Ilone, ,h<y Ihould break '1. I r i. o( eonfequencc alfo ,h..
the tceth clo DQt reach farther towards lhe joint Ihan here
reprefentt d , bec<tuft' a fmalJ (lone, wbeo received inlo thu
p. rt, being held (all ,hc' e, would o,late !he forceps exeer·
fively. aRd make the extratlioo dtllicult; on which accounr,
Ihe'onfide o( ,he blades ncar tI,e join! Ihould be fmoo!h, Ihal
the none may flip tOwards dre tt eth.
B, A doref!or 01' Ilee! , ufed for !he diref!ioo of !he
gorget, in ,he eXlratlloo ar the (lor.e frorrí women.e, A (coop to I"ke away lhe Itone when it is broken ¡oto
fm all pieees like fand. This inllrument is 01 Hee!.
O[ Ih, EM ' YEM".
TH a operation fol' the empyema generally impJies an arti.
fici31 opening made iota the cavity o( the thorax, by which
we eV2cuale any fluid that lies :here ex:ravaf.ued, and 1S be–
come dangerous by lIS weight and quantity_ T he fluid! de–
fcribéd as oecelfary to be voided by Ihis opériftion, are bJood,
malter, and water o
' Viren blood is !he fluid. fuppofed !o require evae"arion
by this method, it is always extlavarated lhrough fome wouod
of ,he velfels of ,he lung' or ,horax. and being difeh.rged
iD great quanlilies OD the diaphragm , is fald lO Oppttr, re–
rpiration, till Jet out by rome convenient opening mclde iD the
moO drpeoding put of thar cavity, wh:ch ¡s the only kmd
of per(oration into che thorax drOingulÍhed hy the name of
the operatio!. for ,be empJulIQ : Rut though rhis openiog i,
nniverfally recommendl'd iDthe cafe here ltated, yet we meel
with (ew or no example, wbere it has beeo pratlifed lor a
mere extravaf;tti('\n o( blood.
To empty the thorax, in a rupture of any ,velfc!s which
open into it, bleeding iS"very necelfary; which nOI ooly flop'
the hz:morrhage, by abating the force of the circularion ;
but hkewire, by unloading tbe velfels of their contenn,
maL:.l!s them more fi t lO receive ,he eXlranJated fl uid byab–
forption: gende evacl1AtioAS and petlorals are alfo very fer–
yic!iible, and alow diet is abfolutely nece!!.ry.
o The {econd cir.cum(lance in which chis opendao takes
plact', is a rupture o( malter from lhe ,/~ura lIuJiaflinum
or lungs inlo the cavity o( the thorax, wher, accumulatiog
it at length proves fatal (or want of a difcharg.e¡ lt is [fue.
lhat the cafe occ;urs but 'Hry fddom, wbere the operation
is Decelfar.y¡ becauf., in mon .bfce!f" of ,he !horax. rhe
mallet