The practice of surgery . with inspec-tion of the male bladder. More than ten years ago Kelly popularizedcystoscopy of the female bladder, and his method is still that commonly DIAGNOSIS IN RENAL DISEASE 363 employed. With the patient in the exaggerated knee-chest or the Tren-delenburg position, the female bbuUler may be inspected directly throughan open tube, the ureters may be observed, and the ureteral cathetermay be passed. The illustration shows Kellys method, but personalinstruction in the clinic is necessary if one would learn and apply thetechnic. A more complicated instrument is requi
The practice of surgery . with inspec-tion of the male bladder. More than ten years ago Kelly popularizedcystoscopy of the female bladder, and his method is still that commonly DIAGNOSIS IN RENAL DISEASE 363 employed. With the patient in the exaggerated knee-chest or the Tren-delenburg position, the female bbuUler may be inspected directly throughan open tube, the ureters may be observed, and the ureteral cathetermay be passed. The illustration shows Kellys method, but personalinstruction in the clinic is necessary if one would learn and apply thetechnic. A more complicated instrument is required for inspectionof the male bladder, but all the instruments used are adaptations of thewell-known Xitze apparatus. I need not discuss the great variety ofingenious inventions and modifications of the cystoscope further thanto mention the names of such investigators as Hill, Fenwick, Thompson,Boisseau, du Rocher, Casper, Akbarran, and Tilden Brown. Brownhas devised one of the simplest of catheterizing cystoscopes. Such. Fig. 230.—Speculum with oblique end for collecting the urine directly from the ureter (Kelly-Noble). instruments generally can be used with the aid of local anesthesiaonly. First one explores thoroughly the bladder in order to deter-mine the presence of stone, of tumor, of ulceration, or of otherlesions which may complicate the diagnosis. Then one inspects theureteral openings, noting any swelling, pouting, pus or blood fromthe ureters. By watching the contractions of the ureteral openings,the spurtings of urine and the intervals between them, one gains someinformation about the activity of the kidneys. B}^ giving certain drugswhich color the urine two purposes are answered. Methylene-blue andindigo carmin make the urinary whirl more visible, and in the case ofnormal kidneys the colored stream should appear in the bladder in fromfifteen to thirty minutes after the drug has been taken. A crippledkidney passes on the colored stream after a longer interval. Hav
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1910
