. The principles and practice of surgery. the operation of Cheselden. Preparation for the Operation.—No doubt much of the success ofcertain operators has depended upon a careful attention to the generalcondition of the patient, and of the bladder especially, before undertak-ing the operation ; although these considerations, it must be admitted,are of somewhat less importance in relation to lithotomy than when it is proposed to make the ope-Fis- 42°- ration of lithotrity. It may not be possible always to re-establish, in all the organs ofthe body, the perfect perform-ance of their respective fu
. The principles and practice of surgery. the operation of Cheselden. Preparation for the Operation.—No doubt much of the success ofcertain operators has depended upon a careful attention to the generalcondition of the patient, and of the bladder especially, before undertak-ing the operation ; although these considerations, it must be admitted,are of somewhat less importance in relation to lithotomy than when it is proposed to make the ope-Fis- 42°- ration of lithotrity. It may not be possible always to re-establish, in all the organs ofthe body, the perfect perform-ance of their respective func-tions, especially while the cal-culus remains in the bladder;but as far as practicable thisshould be done by such meas-ures as the judgment of thesurgeon may suggest. The position, size, andchemical character of thestone should be learned byexploration, and by chemicalanalysis of the urinary sedi-ments ; on the morning preceding the operation, the bowels should beemptied by a gentle cathartic ; three or four hours before operating,. Cheseldens Operation. LITHOTOMY BY OBLIQUE INCISION. 845 Fig. 421. the rectum should be washed out by an enema of tepid water, andfarther alvine movements prevented by the exhibition of from one-quarter to one-half a grain of opium by the stomach. Smaller doses,it is unnecessary to say, would be required for children and patient should be directed to retain his urine from the time therectum is emptied by the enema; and if it is found that he has beenunable to do so, six or eight ounces of tepid water should be injectedbefore the operation is commenced. He must then be placed upon asuitable operating table, or upon an ordinary, firm kitchen table, pro-perly prepared with folded blankets and pillows. When anaestheticsare not employed, the hands must be made fast to the feet by ordinarycotton or flannel rollers, in the manner representedin the preceding wood-cut; but when anaestheticsare used it is unnecessary to tie the patient. Thef
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