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
The operation should be done slowly and with great gentleness, giving
the urethra time “to swallow the instrument,” as the French surgeons
express it. Hasty or forcible movements tend to thrust the point
against the wall of the urethra, where it hitches, if it does not
penetrate and make a false passage. However easy the introduction
may have been, the withdrawal of the catheter should be always done
slowly to avoid giving pain to the patient.
When the canal suddenly contracts, as from a stricture, the point
of the sound often stops at the obstruction; by withdrawing the
instrument a little, and diverting its point to another side or
along the upper part of the urethra, a part where the obstruction
is less abrupt will often be found to let the catheter glide into
the stricture. The floor of the urethra should always be avoided, as
false passages nearly always branch off from the floor close to the
stricture.
Difficult narrow strictures are most easily overcome by injecting
a drachm of warm olive oil into the urethra, and then passing fine
black gum or whalebone bougies (_bougies filiformes_) along the
urethra. These, from their fineness (their diameter is only ⅓ or ⅔
of a millimetre, about 1/100 inch), are very apt to catch in false
passages; if so, the bougie should be left engaged in the false
passage, and held in the left hand while another bougie is passed
along the urethra; if, in its turn, this one gets into a false
passage, it also should be left, and a third passed; and so on till
all the false routes are occupied, or a bougie enters the stricture
and reaches the bladder, which is known by the readiness with which
it will pass backwards and forwards. The other bougies should then be
withdrawn, and the bougie which has passed the stricture be tied in
for twenty-four hours, until the passage is sufficiently dilated to
allow a small catheter to replace it. If the patient is not suffering
from retention of urine, there need be no anxiety about evacuating
his bladder, as urine will find its way alongside the bougie when
he attempts to make water. In passing to relieve retention, No. ½
English flexible catheter should be used instead of bougies; but
when the stricture is too narrow for these, a bougie may still be
tried, as the urine will generally dribble alongside the bougie with
sufficient rapidity to relieve the patient.
_English flexible Catheters_ should be kept on stylets curved as
represented in fig. 85, that the first 3 inches of the instrument,
when the stylet is withdrawn, may retain sufficient curve to ride
over the impediment at the neck of the bladder. In warm weather,
after being oiled, they should be dipped in cold water just before
using, to render them a little stiffer, and less likely to lose their
curve while traversing the urethra.
They may also be passed while the patient lies or stands, and the
movements are the same as for the silver catheter.
Public-domain text, read in full here on John Shaqi.
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