Operative surgery . ion under urgent cir-cumstances- The patient is placed in the lithotomy position, and the leftindex finger introduced into the rectum, and its tip pressed against the apex 1258 OPERATIVE SURGERY. of the prostate (Fig. 1512). A double-edged knife is then plunged into the-perinaium in the median line, the point being directed to the tip of the fin-ger, and caused to openthe urethra in front of theprostate, behind the stric-ture, by a slight lateralmotion. As the knife iswithdrawn, the dimensionsof the wound may beincreased anteriorly. Agrooved director is thencarried into the
Operative surgery . ion under urgent cir-cumstances- The patient is placed in the lithotomy position, and the leftindex finger introduced into the rectum, and its tip pressed against the apex 1258 OPERATIVE SURGERY. of the prostate (Fig. 1512). A double-edged knife is then plunged into the-perinaium in the median line, the point being directed to the tip of the fin-ger, and caused to openthe urethra in front of theprostate, behind the stric-ture, by a slight lateralmotion. As the knife iswithdrawn, the dimensionsof the wound may beincreased anteriorly. Agrooved director is thencarried into the bladderthrough the opening, anda catheter passed upon itto relieve the distendedviscus. The opening maybe made through the an-terior wall of the rectum when objections exist to the perineal puncturcThe knife should not be withdrawn until the director is passed into thebladder, otherwise the liiie of incision may be lost. Suprapubic aspirationshould be employed in place of rectal and urethral tapping, when Fig. 1512.—Tapping urethra. MISCELLANEOUS OPERATIONS. Psoas Abscess.—Psoas abscess can be opened directly from behind withcomparatively little danger, and with the attainment of good Israel operated first, to Treves more than to any one else belongsthe credit of the establishment of the simplicity of the operation from ananatomical standpoint. The Anatomical Points.—The width of the erector spinas muscle (aboutthree inches), and the arrangement of the lumbar fascia with reference tothe erector spina?, the quadratus lumborum, and the psoas magnus muscles,and to the borders of the vertebra?, should be carefully noted before opera-tion (Figs. 1033 and 1034). The length and shape of the transverse processesof the lumbar vertebrae and their connections should be recalled also. Thedetail of the origin of the psoas magnus, the course of the lumbar vessels, therelation of important vessels and nerves to the anterior surfaces of the bodiesof the vert
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