. The principles and practice of surgery. complications exist, and whenno accidents have happened, the operation is now completed, and thepatient is only to be laid in bed, resting upon his back, with the kneesslightly elevated by pillows and separated moderately. It is scarcelynecessary to remind the operator that arrangements must be madeto protect the bed from the urine which will, for a few days at least,escape by the wound. Until quite recently most operators have thought it necessary tointroduce into the bladder, through the wound, a full-sized gum-elastictube, in order to lessen the dan
. The principles and practice of surgery. complications exist, and whenno accidents have happened, the operation is now completed, and thepatient is only to be laid in bed, resting upon his back, with the kneesslightly elevated by pillows and separated moderately. It is scarcelynecessary to remind the operator that arrangements must be madeto protect the bed from the urine which will, for a few days at least,escape by the wound. Until quite recently most operators have thought it necessary tointroduce into the bladder, through the wound, a full-sized gum-elastictube, in order to lessen the danger of urinary infiltration. For someyears we have omitted to do so, and we have seen no reason to regretthe omission; we think, also, that most American surgeons adopt thesame practice. The objection to the introduction of a tube in thesecases is the same which has already been stated in the treatment ofgunshot wounds of the bladder; it causes some irritation, and experienceseems to have shown that it is unnecessary. Fig. 429. Fig. Encysted Stone. Exterior of the Bladder,cuius seen through incision at a. Cal- Interior of the same. a, orifice leading to cyst; 6ureter. When the calculus is encysted itstempted, unless it be by the high operation extraction ought not to be at- but this fact may not be ELEMORKHAGE AFTEE LITHOTOMY. 851 Fig. 431. known until the bladder is opened; and in case the operation has beenattempted below the pubes, a careful exploration should be made withthe finger or an exploring instrument, to determine the size of theopening in the cyst, and the feasibility of the removal of the stonethrough the perineal incision; and by the knowledge thus obtainedthe subsequent conduct of the surgeon must be governed. If the stone is found to be very large, exceeding, for example, oneinch and a half in its shortest diameter, and cannot be removed by theincision already made, either one of the followingalternatives may be considered : the calculus maybe broken by t
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