Identifier: principlespracti1872hami (find matches)
Title: The principles and practice of surgery
Year: 1872 (1870s)
Authors: Hamilton, Frank Hastings, 1813-1886
Subjects: Surgery General Surgery
Publisher: New York : W. Wood & Co.
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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s seized. The stone being crushed, if the operation has occasioned but little orno irritation, and the patient gives no sign of weariness, the blades 842 LITHOTRIPSY. may be opened and the operation repeated upon the fragments, a secondor even a third time. The blades should then be closed, the end of theinstrument slightly concussed to complete the disengagement of thefragments, and carefully withdrawn. The patient should now be placed in bed, and allowed to take a glassof hot gin and water in sufficient quantity to encourage sleep and a gen-tle perspiration. By this means the irritability of the bladder will bemade to subside more quickly, and the chill, which occasionally results,may be obviated. No stimulants should be allowed subsequently; thediet should be simple, and water alone may be drunk freely. In orderto prevent the lodgment and impaction of fragments in the vesical por-tion of the urethra, the patient should evacuate his bladder while lyingupon his back in bed. Fig. 419.
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Seizure of the Stone by Heurteleups Method. The interval between the first and second operation will be more orless prolonged according to the condition of the bladder. In general itmay be stated that the operation is not to be repeated while fragmentsare passing daily, and perhaps not until two or three days have elapsedsince they ceased to pass. If fragments do not escape after one or twoevacuations of the bladder in the recumbent posture, the patient may bepermitted to urinate standing, or the bladder may be injected with tepidwater and then emptied rather suddenly while standing. If fragmentsbecome engaged in the vesical or membranous portion of the urethra,they should be pushed back by a large flexible catheter; but if theyare lodged in front of the membranous portion they may sometimes bepushed forwards by careful pressure with the fingers ; or they may beevacuated by checking the flow of urine by pressure made behind thefragment, and then allowing it suddenly to flow again. The

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