Operative surgery . odyne and possibly ten grains of quinine, and keep the patient quiet. The Comments.—The ability to detect the click of small stones andfragments by aid of the searcher is greatly enhanced by the attachment ofthe so-called lithophone. This attachment can be extemporized by takinga piece of rubber tubing, twenty-five or thirty inches in length with aneighth of an inch caliber; double one end upon itself and place it againstthe handle of the searcher, allowing also the tubing continuous with it to liealong the handle, or push it into the open end of the handle of the searcher.
Operative surgery . odyne and possibly ten grains of quinine, and keep the patient quiet. The Comments.—The ability to detect the click of small stones andfragments by aid of the searcher is greatly enhanced by the attachment ofthe so-called lithophone. This attachment can be extemporized by takinga piece of rubber tubing, twenty-five or thirty inches in length with aneighth of an inch caliber; double one end upon itself and place it againstthe handle of the searcher, allowing also the tubing continuous with it to liealong the handle, or push it into the open end of the handle of the other extremity is then placed in the ear directly, or connected to it bythe medium of an otoscope (Fig. 134G). The ability to detect fragments ofan almost infinitesimal size is said to be thus attained (Fig. 1347). The wash-ing process of litholapaxy will also cause the click, when other measures have failed. The Fallacies.—The fallacies of sounding Fig. 1347. -Billroths sounding-board attached are quite numerous, as a stone may be obscured more or less by mucous membrane, inspissated mucus, or blood, and when pocketed in an adventitious place. Calcareous incrustations connected with the wall of the l)la(lder, or with a morbid growth, are sometimes mistaken for calculi. Finsilly, the instrument may not enter the bladder at all, and thus completely deceive the examiner. Bimanual Palpation.—Bimanual palpation can be practiced in either sexwith satisfactory results if the patient is not of an unusual muscular or adi- OPFRATTOXS OX TIIH rinXAIIV ULA DDi:!?. 1159 pose dovelopnioiit. In tlio riiiilo tlie })iititnt is phutd usually on tlio ]>afk, withtiie thighs lloxcd tmd the shoulders raised so us to relax the abdominal examiner introduces the index finger of tiie right hand into the rectumof the patient, and presses the tips of the fingt-rs of the left behind thepubes and the bladder. Between the apposing linger tips an empty bladder/•/ToSv ?^
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