File:An analytical compendium of the various branches of medical science, for the use and examination of students (1848) (18167254602).jpg

Title: An analytical compendium of the various branches of medical science, for the use and examination of students
Identifier: analyticalcompen00neil (find matches)
Year: 1848 (1840s)
Authors: Neill, John, 1819-1880; Smith, Francis Gurney, 1818-1878
Subjects: Anatomy; Physiology; Surgery; Obstetrics; Medicine; Materia Medica
Publisher: Philadelphia, Lea and Blanchard
Contributing Library: Univ. of Mass Medical School, Lamar Soutter Library
Digitizing Sponsor: Univ. of Mass Medical School, Lamar Soutter Library

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88 SURGERY. can be protruded after its introduction into the bladder. These claws are equally liable to catch the coats of the bladder as well as the stone, and the operation has been superseded by the following. LITHOTRIPSY. This implies the crushing of the stone whilst in the bladder; and it is preferred to all other operations for disintegration. The cases most favourable for this operation are adults, where the urethra is free from stricture, the bladder free from irritability and not contracted, and the prostate not enlarged. A mulberry calculus would be unfavourable for lithotripsy, on account of its hard cha- racter. The instrument most frequently used is that of Heurteloup, or a modification of it. It consists of two blades, which slide one upon Fig. 26.
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the other, the extremities being slightly bent. It can be introduced into the bladder as a sound or catheter, and afterwards the blades are separated, to grasp the stone. In the original instrument the male blade was struck with a hammer, and thus the stone was broken ; now the crushing power is that of a screw, variously adapted,—that of Mr. Weiss being most simple and perfect. The extremities of the instrument have teeth, so as to retain the stone when grasped, and Fig- 27. also fenestrae to allow of the escape of sand or pow- dered stone. The patient must be previously prepared for the operation, by regula- tion of the general health, dilatation of the urethra, and distension of the bladder. The patient lies on a convenient table or bed, with the pelvis ele- vated, so as to throw the stone into the fundus of the bladder ; the bladder must be full, so as to prevent its coats from being entangled in the instrument. If urine cannot be retained, tepid water must be injected. The instrument must be oiled and warm.

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