. Surgery, its principles and practice . h theTilden Brown or the Bransford Lewis cystoscopes, the washing may bedone through the sheath of the instrument, which carries a large, fullstream back and forth; and no time need be lost in inserting the catheter-izing telescope through the sheath after the cleansing is effected. * Plans and specifications completed, but delayed in execution. 286 SURGERY OF THE BLADDER. A sufficient quantity of fluid must be introduced to afford workingspace for the cystoscope. Less than three ounces in the bladder is im-practicable; from five to ten ounces is servic
. Surgery, its principles and practice . h theTilden Brown or the Bransford Lewis cystoscopes, the washing may bedone through the sheath of the instrument, which carries a large, fullstream back and forth; and no time need be lost in inserting the catheter-izing telescope through the sheath after the cleansing is effected. * Plans and specifications completed, but delayed in execution. 286 SURGERY OF THE BLADDER. A sufficient quantity of fluid must be introduced to afford workingspace for the cystoscope. Less than three ounces in the bladder is im-practicable; from five to ten ounces is serviceable; while some veryatonic bladders are best examined when containing even more than that are contracted or intolerant of sufficient fluid are renderedmore tractable by elevating the pelvis (semi-Trendelenburg posture),which removes the pressure from the neck, the tenderest part. Anesthesia.—It is only in a few exceptional cases that general anes-thesia is required, some form of local anesthesia amply sufficing for the. Fig. 161.—Position for Cystoscopy and Catheterization of the Lewis Cystoscopic Table. The Brans- remainder, with the exception of the few in which no anesthetic at all isnecessary. The posterior urethra and the vesical neck are the points requiringthe anesthetic influence, the anterior urethra and bladder Avall in generalrequiring none at all. The favored mode of securing this effect has been that of depositing20 or 30 minims of a 4 per cent, solution of cocain in the posteriorurethra, after emptying the bladder of all contents. The solution thusdeposited is not inclined to remain in the posterior urethra, but under theinfluence of the muscular apparatus surrounding the canal passes backinto the bladder and soon mixes with the urine as it comes from theureters. It is thereby diluted, and its effect is transient. While this DIAGNOSIS OF VESICAL AFFECTIONS. 287 method is serviceable to a degree in patients not extremely sensitive,i
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