. The principles and practice of surgery. leeding and demand interference. In the case ofsuperficial vessels there is usually no difficulty in applying the ligature ;but when the source of the haemorrhage is in the deeper portions of thewound, a ligature can seldom be applied. Physicks artery forceps, orsome other instrument constructed to hold a needle armed with a stoutligature, is sometimes useful in these emergencies; but since it is al-most impossible to determine the precise source of a deep haemorrhage,they cannot often be employed successfully. There are two expe-dients which give the
. The principles and practice of surgery. leeding and demand interference. In the case ofsuperficial vessels there is usually no difficulty in applying the ligature ;but when the source of the haemorrhage is in the deeper portions of thewound, a ligature can seldom be applied. Physicks artery forceps, orsome other instrument constructed to hold a needle armed with a stoutligature, is sometimes useful in these emergencies; but since it is al-most impossible to determine the precise source of a deep haemorrhage,they cannot often be employed successfully. There are two expe-dients which give the best promise under these circumstances, namely,continuous pressure with the finger, made by a relay of assistants ; orthe canula enclosed with a sac in the manner which has already beendescribed. This latter being introduced well into the bladder throughthe wound, the operator proceeds to stuff the sac, outside of the canula,with lint, either dry, or moistened with the persulphate of iron, untilthe compression is deemed to be Stone-Crusher. 852 LITHOTOMY BY MEDIAN INCISION. If this proves successful, a portion of the lint may be removed asearly as the second day, so as to diminish the pressure, but the canulashould not be disturbed until the seventh or tenth day, when it will befound loosened by the suppuration. Median Operation, Syn., A Media Parte, R. O.; Marian Operation. This process—the essential peculiarities of which consist in makingthe primary incision vertical, or in the line of the raphe, in front ofthe anus, and dividing longitudinally only the membranous portion ofthe urethra—was probably in use as early as the 14th or 15th cen-tury, but Mariano Santo first published an account of it about theyear 1535. Since then the operation has undergone many modifications,the last of which was in the hands of Mr. G. Allarton, of England,in 1854. Mr. Allartons operation is as follows :—The patient being preparedand placed as for the lateral incision—with an
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