Practical observations on the lateral operation of lithotomy / by William Keith.

  • Keith, William, 1802 or 1803-1871.
Date:
[1844]
Catalogue details

Licence: Public Domain Mark

Credit: Practical observations on the lateral operation of lithotomy / by William Keith. Source: Wellcome Collection.

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    I 30 proposition. If so large, that the dilating quality of the bladder, with both sides of the prostate cut, is not likely to admit of the passage of the stone, then the high operation would form an infi¬ nitely preferable mode of giving it an easy and a safe escape, and should be selected. 2. Haemorrhage I always view with apprehension. A state of depression happens after this operation in almost every case, which I find much aggravated by even what is called a moderate, by some an advantageous haemorrhage. It may be because I bring none to the table in a state to require depletion ; but be that as it may, when the transversails perinei artery bleeds with any vigour, I invariably lay down the knife, and with a tenaculum, or the spring forceps, take up and tie the bleeding vessel. I never oper¬ ate against time; my sole object is to save my patient’s life, and this proceeding has therefore every thing to recommend it. The vessel is at the moment easily seen and secured; not so in a little after, when the parts get infiltrated with blood. The after steps of the operation are carried through calmly, as no continuing haemor¬ rhage hurries you—the urine comes away afterwards clear at a more early period, much to the relief of the surgeon; and the pa¬ tient’s strength is husbanded. Should the artery of the bulb be cut, there presents only an additional reason for instantly adopting measures for effectually suppressing the flow of blood. I have elsewhere in this paper showm how it may be easily commanded. I have succeeded, by the pressure of sponge plugs dipped in tinc¬ ture of benzoin, surrounding a tube, and pressed in between the rami of the pubis. The case recovered, but the hook is more to be depended on. Better far, however, to cut low and escape such a casualty. 3. I will not deny that the operation I advocate does en¬ danger the rectum; but I must say, with ordinary care, injury to it is not likely to happen. The first incision only requires depth at its upper angle, for about one-third of its length ; the remaining two-thirds ought to shallow rapidly, requiring little more than the integument to be cut, as the tissues beneath are elastic in a high degree, and yield readily during the extraction of the stone. I am quite convinced that the rami of the pubis have most commonly been the cause of the many desperate struggles we have heard of and seen in the extraction of calculi. There seems to be an unusual fear in the minds of some surgeons at the idea of wounding the