The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . reon the other side ; and, lastly, directs the end of the instrument by rais-ing its handle into the lower fundus, which he carefullj explores. Usuallythe stone is readily detected by these manoeuvres, and its position in thebladder will often be dependent upon, and may to a certain extent betaken as an approximative indication of, its size. Thus, when mode-rately large, it will usually be found lying to one side, most generallythe right, of the neck of the bladder; when small, it will be placed
The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . reon the other side ; and, lastly, directs the end of the instrument by rais-ing its handle into the lower fundus, which he carefullj explores. Usuallythe stone is readily detected by these manoeuvres, and its position in thebladder will often be dependent upon, and may to a certain extent betaken as an approximative indication of, its size. Thus, when mode-rately large, it will usually be found lying to one side, most generallythe right, of the neck of the bladder; when small, it will be placed to-wards the fundus, near the orifice of one or other ureter. These thenare the situations in which the Suigeon should first seek for a stone, andin which he will generally find it when present. Should it not be metwith here, the chances are, more especially if the patient be elderly, thatit will be found in a pouch behind the prostate, where it may be detectedby depressing tlie handle and so turning the beak of the sound down-wards (Fig. 725). Should the Surgeon not detect the calculus in any. Fig. 725.—Sounding for Stone behind Prostate. of these situations, he depresses the handle between the thighs, and tiltsup the beak so as to examine the pubic portion of the organ (Fig. 726),In the event of his not meeting with a stone, he may direct the patientto stand up, and then he may explore the bladder, first on one side,then on the other. Should the rational symptoms of stone be wellmarked, though no calculus be struck, the Surgeon must not give adecided opinion in the negative after the first exploration, but shouldexamine the patient again a few days later, with the bladder in differentstates as to its contents. In making this second examination, I havefound it of great service to use a hollow steel sound, hy which the organ SOUNDING THE BLADDER. r33 can be injected or emptied at pleasure (Fig. *72T). The patient shouldon this occasion have his bladder injected through such a
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