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Identifier : surgeryitsprinci04keen
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hey can usually be felt by digital examination ofthe rectum. In all doubtful cases an x-ray photograph should be taken.When a small stone only partially obstructs the urethra and cannot befelt on palpation, a stone-searcher should be inserted into the urethra.Wlien the instrument comes in contact with the stone, a gritty sensationwill usually be imparted to the examining hand. An endoscopic examina-tion will generally reveal the presence of small stones embedded in theurethra. Treatment.—The method of extracting a concretion that has orig-inated in the urethra differs from that pursued when the canal is occludedby fragments of vesical or renal calculi. The various instruments de-vised for extracting ordinary foreign bodies cannot be used in such cases.As the calculus is either held fast behind a tight constriction or is partlyencysted, the concretion can safely be removed only by performing anexternal urethrotomy. The urethra may be incised externally on the floor, in any portion of
RETENTION OF URINE. . 513 its course, with perfect safety, and with far better results than can pos-sibly be attained by attempts at extracting foreign bodies with hooks,scoops, or forceps. When a stone is lodged behind a contracted meatus or is embedded inthe fossa navicularis, it can readily be reached by performing meatotomy,or by making an incision on the floor of the urethra of sufficient length torender extraction easy. If the stone is not too large, it may be graspedby a pair of urethral forceps, through a small incision on the floor of thecanal, and then crushed, and the fragments removed with a small scoopor by irrigation, the incision being closed by a few fine silk sutures. Whenthe body is lodged in the penile urethra behind a tight structure, an ex-ternal urethrotomy should be performed. The stone can easily be de-tected on palpation as a hard mass on the under surface of the urethra.It should be grasped between the index-finger and thumb of the lefthand. An incision shoul
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Identifier : surgicalaftertre00cran
Digitizing Sponsor : Open Knowledge Commons
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Infectiononce started calls for more frequent irrigations and the relentless useof the knife. All the tissues must be laid wide open. Hot soaks in asitz-bath are invaluable and comforting. Uncontrolled infections havea direful tendency to spread upward along the urinary tract, where thedifficulty of combating them is doubled.33 514 OPERATIONS ON PENIS, SCROTUM, URETHRA, AND PROSTATE Comfort of the Patient.—Hardly anything more uncomfortablecan be imagined than the postoperative genito-urinary case, with hisurine constantly dribbling away, beyond his control, keeping his dressingwet and diffusijiig a rank odor of stale urine. Nothing can be too trivialto perform which will add an atom of comfort. Use large absorbentdressings and change them every hour if necessary. A little mentholor charcoal sprinkled in the dressing will disguise or absorb the odormarkedly. Keep the edges of the wound and the surrounding skinsmeared with zinc-oxid ointment to protect the skin, which easily becomes
Fig. 169.—Convenient Method for Perineal Dressings. red, burning, and itching from the constant bath of urine. Bed-soresform quickly if the patient lies for hours in a wet dressing or a wet bed,and are difficult to heal. CIRCUMCISION The method of dressing whereby a roll of gauze is tied along thewound by the long ends of the interrupted catgut sutures is ingenious,but is not to be commended. • This ring of gauze gets heavy and sti£fwith blood, gets foul in odor, and gets loose here or there irregularly,according as one or another stitch gives way. Interrupted catgut stitchesshould be used, cut short. MEATOTOMY 515 At the end of operation on an adult the glans should be coveredwith a plentiful mass of eucalyptus vaselin (5 per cent.), the region ofthe wound bandaged with a few turns of some kind of chemical gauze,held in place by a narrow adhesive strip, barely tight enough to holdit. An infant needs no fixed dressing. A mass of absorbent cottonshould now envelop the organ, and t
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Identifier : historyofuniteds00coop
Contributing Library : The Library of Congress
Digitizing Sponsor : Sloan Foundation
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h 1 First finger 1 Adhesions broken up, due to adhesion of ileum 1 Circumcision 5 Curettment of bone 5 Debridement 30 Enucleation: Right eye 3 Left eye 2 Foreign bodies removed from: Right hand 2 Left hand 1 Right shoulder 4 Abdomen 1 Left leg 3 Buttocks 7 Right thigh 6 Neck 2 Left knee 1 Head 7 Face 1 Jo ram o Left shoulder 1 Left arm 15 Left fore arm 19 Right arm 8 Right fore arm Ii Hemorrhoidectomy 20 Herniotomy, single 7 double 1 Hydrocele, tapped 2 Ligation: Brachial, artery 1 Axillary artery 2 Sub-clavian artery, 2nd portion 1 Ulnar 1 Laminectomy, shrapnel removed from spinal cord 1 Mastoidectomy 5 Mastoid wound drained 1 Meatotomy 2 Orchectomy 1 Rib—resection, 7th left side 1 Removal of ingrovi^ing toe-nail 1 corn 1 cervical glands 2 tumor from right axilla ■ 1 Skin graft on right arm 1 Secondary suturing: Multiple GSW 9 Shoulder 5 Right arm 1 Left -arm 2 Neck 1 Right hip 2 Thyroidectomy 2 Trephine 10 Aspiration of pleviral cavity 7 Blood transfusion 3 Varicocelectomy 4 266
Major James M. Patton. Capt. Eugene Smith, Assistant. Eye Department Base Hospital 36, A. E. F. Base Hospital 36. VitteL-The eye clmic here was in charge of Capt. W. B. Haughey,who had the best and most complete equipment for ophthalmic surgery of any of the then activeAmerican hospitals in France. This equipment was brought with Base Hospital 36 and Mus-tratcs the great advantage of having each base hospital transport its own special equipment. TwoLancaster magnets were found installed and a room devoted to the use of the eye clmic. BaseHospital 23, which was in close proximity to Base Hospital 36, also had an eye dime, but with-out adequate equipment for ophthalmic surgery. An optical unit was, however, first assigned toBase Hospital 23, in a room provided for it, as most of the refraction work was being donehere Later Maj. J. M. Patton was assigned to Base Hospital 36 to take charge of the eyework and organize an eye center for the Vittel atid Contrexeville area. Several rooms at B
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Identifier : historyofuniteds00coop
Contributing Library : The Library of Congress
Digitizing Sponsor : Sloan Foundation
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h 1 First finger 1 Adhesions broken up, due to adhesion of ileum 1 Circumcision 5 Curettment of bone 5 Debridement 30 Enucleation: Right eye 3 Left eye 2 Foreign bodies removed from: Right hand 2 Left hand 1 Right shoulder 4 Abdomen 1 Left leg 3 Buttocks 7 Right thigh 6 Neck 2 Left knee 1 Head 7 Face 1 Jo ram o Left shoulder 1 Left arm 15 Left fore arm 19 Right arm 8 Right fore arm Ii Hemorrhoidectomy 20 Herniotomy, single 7 double 1 Hydrocele, tapped 2 Ligation: Brachial, artery 1 Axillary artery 2 Sub-clavian artery, 2nd portion 1 Ulnar 1 Laminectomy, shrapnel removed from spinal cord 1 Mastoidectomy 5 Mastoid wound drained 1 Meatotomy 2 Orchectomy 1 Rib—resection, 7th left side 1 Removal of ingrovi^ing toe-nail 1 corn 1 cervical glands 2 tumor from right axilla ■ 1 Skin graft on right arm 1 Secondary suturing: Multiple GSW 9 Shoulder 5 Right arm 1 Left -arm 2 Neck 1 Right hip 2 Thyroidectomy 2 Trephine 10 Aspiration of pleviral cavity 7 Blood transfusion 3 Varicocelectomy 4 266
Major James M. Patton. Capt. Eugene Smith, Assistant. Eye Department Base Hospital 36, A. E. F. Base Hospital 36. VitteL-The eye clmic here was in charge of Capt. W. B. Haughey,who had the best and most complete equipment for ophthalmic surgery of any of the then activeAmerican hospitals in France. This equipment was brought with Base Hospital 36 and Mus-tratcs the great advantage of having each base hospital transport its own special equipment. TwoLancaster magnets were found installed and a room devoted to the use of the eye clmic. BaseHospital 23, which was in close proximity to Base Hospital 36, also had an eye dime, but with-out adequate equipment for ophthalmic surgery. An optical unit was, however, first assigned toBase Hospital 23, in a room provided for it, as most of the refraction work was being donehere Later Maj. J. M. Patton was assigned to Base Hospital 36 to take charge of the eyework and organize an eye center for the Vittel atid Contrexeville area. Several rooms at B
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Identifier : historyofuniteds00coop
Contributing Library : The Library of Congress
Digitizing Sponsor : Sloan Foundation
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Pvt. First Class Henry AprilPvt. First Class Arthur HamiltonPvt. First Class John ConwayPvt. First Class Oran C. AllenPvt. First Class Donald McQueenPvt. First Class Otto SkripsyPvt, First Class Michael DombroskiPvt. Claud CutrellPvt. Robert BroylesPvt. Charles Blackburn Pvt. Edward Parker Pvt. Clint A. Crooks Pvt. Leo Forsha Pvt. George E. Farr Pvt. J. E. Clifton Pvt. First Class Goddie Phillips Pvu First Class Thomas L Wood Pvt. Founaris Hosp. Sot. Bernard A. Harrigan Sgt. First Class Lee Joslyn, Jr. Sot. First Class Samuel Backus Sgt. First Class Joseph Varion Sgt. First Class William Pulkinghorn Sgt. First Class Chas. E. Bohn, died of pneumoniaSgt. Vance BuchananSgt. Edward VanderlineSgt. Howard KramerSgt. Carl SitterSgt. Windsor D. SchuylerSgt. Asa BakerSgt. Albert BarnettSgt. Arthur P. BogueCpl. Wilbur T. Huddle, secretary todental department Cooks John AvalierClarence EwaldThomas HamiltonJack MorrisColin T. BainJack BayneJohn G. MrockFrank P. Burg winAlbert DavidsonPhillip Bear
7/(1 Fuld ^tLiili::ci and the Cootu Eitii minatoi-Bill Wright. >pi-r,iiinij Room, Hospital A. Hospital A Report from Dec. 8. 1917. to Jan. 1. 1919 OPERATIONS Appendectomy 6 Arthrotomy of right knee 3 Ab.scess drained: Neck 3 Scrotum 1 Fore arm 1 Inguinal glands 1 Amputations: Left arm below elbow 1 Right arm 1 Right thigh 1 First finger 1 Adhesions broken up, due to adhesion of ileum 1 Circumcision 5 Curettment of bone 5 Debridement 30 Enucleation: Right eye 3 Left eye 2 Foreign bodies removed from: Right hand 2 Left hand 1 Right shoulder 4 Abdomen 1 Left leg 3 Buttocks 7 Right thigh 6 Neck 2 Left knee 1 Head 7 Face 1 Jo ram o Left shoulder 1 Left arm 15 Left fore arm 19 Right arm 8 Right fore arm Ii Hemorrhoidectomy 20 Herniotomy, single 7 double 1 Hydrocele, tapped 2 Ligation: Brachial, artery 1 Axillary artery 2 Sub-clavian artery, 2nd portion 1 Ulnar 1 Laminectomy, shrapnel removed from spinal cord 1 Mastoidectomy 5 Mastoid wound drained 1 Meatotomy 2 Orchectomy 1 Rib—resecti
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Identifier : gonorrheainmalep00wolb
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the torturesof pushing a large steel sound through a tight-clinging meatus. A few drops of one per cent, alypinsolution injected into the adjacent tissue, rendersthe. cutting absolutely painless. When, however,the patient refuses to consent to the meatotomy, wemust resort to the use of the urethral dilators. Treatment: Stricture of the Urethra. 153 Urethral Dilators.—These instruments are made soas to pass through a very small meatus, and aredilatable up to about 45 French. The dilating por-tion is covered with a thin rubber sheath. The sim-plest of these dilators are the Oberlander instru-ments. These dilate in one plane only—from abovedownward—the patient lying on his back. The an-terior dilator (Fig. 40) is a short, straight instru-ment, while the posterior dilator (Fig. 41) is curvedto resemble the urethral sound. The Kollmanninstruments dilate in two planes—i. e., they havefour arms—and of course have this advantage overthe Oberlander. These, too, have an anterior (Fig.
Fig, 46. Double taper sound. 42) and a posterior (Fig. 43) variety. They havebeen modified so as to include an irrigating appa-ratus, thus permitting of the irrigation of the canalsimultaneously with its dilation. Fig. 44 showsthe anterior irrigating dilator, and Fig. 45 theposterior. In certain cases where the meatus is dilatable,but contracts quickly, it is sometimes well to usethe double taper sound, illustrated in Fig. 46. Thedrawing shows the measurements at the tip, shankand handle. It will be seen that once the largestdiameter has passed the meatus, the shank is re-duced in diameter, and the meatus is spared thedilatation that is being administered to the canalproper. 154 Gonorrhea in the jMale. Forcible Dilatation.—This method of stretching astricture at one sitting is not to be recommended^except in unusual cases where great rapidity in dila-tation is the essential desideratum. The dilatorsjust mentioned are the best instruments for thispurpose. The process is usually accom
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Identifier : gonorrheainmalep00wolb
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the health of the wife. For the immiediate attack, and the future recordand past history of the case,*! use a card similar tothe one reproduced here. (Fig. 18.) It measures6 by 7 inches, and provides not only for the examina-tion, but for the future and past venereal history oithe patient. On the back of the card, the financialrecord of the case may be inscribed. It is also wellto have on the back of the card, a diagnostic sketch ofthe prostate and seminal vesicles, and the testes(Fig. 19). Any deviations from the normal shouldbe indicated thereon. 106 Gonorrhea in the Male. URETHRITIS i^^lc No Date 19 Name Address Age Duration Number of Attack Treatment (?) OccUpatiori.... Previous Attacks (Duration ) 1st 2d 3d 4th !Pro(uM IRRIGATION TESTS* Urine il^l - -- 1 ^ Frequency|D.,...Mo.nm6,op l2cl...... 2(Con.,oi) 4 M.U Pain..,...iNight. (Married(Single Prostate Vesicles Meatus .Testes Gonocdcci ? Epididymitis. Chief Complaint Stricture. .Joint lesions... Other■Complications ■ Fig. 18.
Fig. 19. Method of Examination. 107 Method of Examination.—It is well to closely ex-amine the meatus urinarius. A small meatus gen-erally bodes no good, and often acts as the interferingfactor in the cure of acute urethritis. If the meatusis small, a mental resolve should immediately bemade to perform a meatotomy at the first legitimateopportunity. If a discharge is present, a smear
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Identifier : surgicaldiseases00keye
Digitizing Sponsor : Open Knowledge Commons
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end of the instrument. It is dis-closed by withdrawal, when it rides upon a ridgewhich is continuous up to the handle. The instru-ment is introduced until the point of emergence ofthe knife is about half an inch behind the deepeststricture to be cut. The blades are then separateduntil the stricture is well upon the stretch. Theknife is withdrawn, cutting the tense tissues. Theinstrument may be then still further screwed up ifdesired, and the cutting continued to any extent—upon the roof of the urethra. The whole roof or al^ortion of it may be cut. The knife is then re-turned, the instrument unscrewed and withdrawn.Cocaine makes the operation comparatively painless.A full-sized sound is then introduced to prove thatthe cutting has been effectual. Ila^morrhage isarrested as in meatotomy, and the after-treatmentis as before with sounds. Wyeths urethrotome, a similar and cheaper in-strument, serves very well as a substitute. It is not as strong an in-strument as that of Professor Otis.
Fig. INSTRUMENTS FOR EXTERNAL PERINEAL URETHROTOMY. Besides some of the special instruments already described, only twoothers are requisite to meet the requirements of external section. 1. A simple staff, broadly grooved on its convexity, the grooverunning off at the end, and the instrument not conical (Fig. 45).This instrument is introduced as far as the stricture, when the latteris impervious, and is cut upon in the operation of perineal urethrot-omy without a guide. It may be used with a guide, the latter beinga whalebone bougie, introduced through the stricture (Fig. 40). In EXTERNAL URETHROTOMY WITHOUT A GUIDE. 123 this case it is practically the same instrument as the stafE of Syme,*the eminent surgeon who gave this operation its reputation. Symesstaff is unsafe compared with the means now at our command, and israrely iised. 2. The catheter-staff of Gouley (Fig. 47). This most excellentinstrument is a metallic catheter (they are made of various sizes),
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ra and bladder. Hemor-rhage, which is not often severe, may be controlled bywinding a strip of rubber plaster about the glans, asrecommended after meatotomy. Beginning forty-eighthours after the operation, a full-sized steel sound shouldbe passed through the stricture a few times at intervalsof three or four days, and then at longer intervals, as intreatment by dilation. To render the result permanent,it is usually necessary to continue the occasional use ofthe sound in the same manner as after treatment bydilation. When strictures of a calibre larger than No. 18 or 20require cutting, the Otis urethrotome (Fig. 52) is prob-ably the best instrument in use. The closed instrument
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