The essentials of bandaging: $b including the management of fractures and dislocations, with directions for using other surgical apparatusHill, Berkeley
Science
The essentials of bandaging: $b including the management of fractures and dislocations, with directions for using other surgical apparatus
Hill, Berkeley
Bandages and bandaging; Dislocations -- Treatment; Fractures -- Treatment; Surgery, Minor
_A Silver Catheter_ is passed most easily while the patient is in a
horizontal position, with the shoulders low and the thighs separated.
The surgeon stands on the left side of the patient, and holds the
catheter, previously warmed and lubricated with oil or lard, lightly
between the thumb and two first fingers of the right hand, the beak
downwards and the stem across the patient’s left groin. Then taking
the penis between the middle and ring fingers of the left hand, the
palm being upwards, he pushes back the foreskin with the thumb and
forefinger, and steadies the meatus while introducing the beak of
the catheter. This done, he draws the penis gently along the catheter
as the point is lowered to the perinæum, but without raising his
right wrist until the instrument has travelled 5 or 6 inches along
the passage and reached the triangular ligament. The surgeon then
carries his right wrist to the middle line of the patient’s body,
and while pushing the point onwards, raises the hand round a curve
till it again sinks between the patient’s thighs. When the bladder
is reached he withdraws the stylet that the urine may escape. Three
points of difficulty are usual in passing catheters; the lacuna magna
just within the meatus, the triangular ligament, and the prostatic
part of the urethra just before the bladder is reached. The first is
escaped by keeping the beak along the floor of the urethra for the
first two inches; the second is best avoided by raising the wrist
as the instrument passes the triangular ligament, and directing the
beak against the upper surface of the urethra, lest, being in the
enlarged bulbous part, it sink below the opening in the ligament; the
third difficulty is overcome by depressing the hand well as the point
approaches the bladder.
_To pass the catheter in the upright position_, the patient is placed
against a wall or firm object, with his heels eight or ten inches
apart and five from the wall, that he may rest easily during the
operation. The surgeon sets himself opposite the patient and grasps
the penis with the two middle fingers of the left hand, the palm
upwards; he next exposes the meatus with the thumb and forefinger,
and his right hand holding the catheter by its middle obliquely
across the left side of the patient, he draws the penis on to the
instrument till the triangular ligament is gained. He then carries
the shaft of the catheter to the middle line and, holding it by its
end, brings the right hand downwards and forwards, to carry the point
upwards over the obstruction at the neck of the bladder.
Public-domain text, read in full here on John Shaqi.
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