File:Aseptic surgical technique - with especial reference to gynaecological operations - together with notes on the technique employed in certain supplementary procedures (1916) (14759037426).jpg

Identifier: asepticsurgicalt00robb (find matches)
Title: Aseptic surgical technique : with especial reference to gynaecological operations : together with notes on the technique employed in certain supplementary procedures
Year: 1916 (1910s)
Authors: Robb, Hunter, 1863-1940
Subjects: General Surgery Gynecology Asepsis Asepsis and antisepsis Surgical instruments and apparatus Gynecology
Publisher: Philadelphia and London : J.B. Lippincott company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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ilators; a series of specula with obtura-tors; an ordinary head-mirror, with some artificiallight, best supplied by an electric lamp; one pair oflong, delicate mouse-toothed forceps; a suction ap-paratus for completely emptying the bladder; a ure-teral searcher, and a flexible silk ureteral catheter. The patient is catheterized, and a small pledget ofcotton soaked in 10 per-cent. solution of cocaine isintroduced into the urethra. In ten minutes thiswill have produced complete numbing in that region.The vulva is then carefully cleaned up, just as for theoperation of D. and C, and the patient is placed in theknee-chest position. The size of the external meatushaving been determined by the calibrator, the dilator ofthe corresponding size is first introduced, and is fol-lowed in turn by the larger ones of the series until theurethra is dilated to a diameter of from twelve tofifteen millimetres, or a little more than half an inch. 230 ASEPTIC SURGICAL TECHNiqUE. 00CO 6 M 03 E3§ n OSeo d M
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03 P. ^ ^ aI 13 3. OS I »^ o \ 231 232 ASEPTIC SURGICAL TECHNiqUE, The necessary degree of dilatation can usually becompleted without more than a slight external rup-ture, and when it has been reached a speculum of thesame size as the last dilator is introduced and theobturator belonging to it is removed. By means ofthe knee-chest position, the pelvis is elevated fromeighteen to twenty inches above the table. Thismanoeuvre causes the bladder to balloon out withair. (Plate XX.) The examination is made withthe aid of the head-mirror and artificial light. Acandle in a dark room suffices if no other light is avail-able. The obturator being withdrawn from the specu-lum, the bladder immediately becomes distended withair, and by properly directing the reflected light it be-comes possible to examine every portion of it. Thereis usually, even after the most careful catheterization,a little residual urine, which can be removed by thesuction apparatus, or, if the amount be trifling, bymeans of

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