The Compleat Surgeon Part 32

It happens when the Intestinal Parts fall into the _s.c.r.o.t.u.m_ in Men, or into the bottom of the Lips of the _Matrix_ in Women. To perform this Operation, the Patient must be laid upon his Back, as in the _Bubonocele_, and the Incision carry'd on after the same manner; which is to {238} be made in the _s.c.r.o.t.u.m_, tearing off the Membranes to the Intestine. Then a Search will be requisite, to observe whether any parts stick to the t.e.s.t.i.c.l.e; if the Caul doth so, it must be taken off, leaving a little Piece on the t.e.s.t.i.c.l.e; but if it be the Intestine, so that those Parts cannot be separated without hurting one of 'em, it is more expedient to impair the t.e.s.t.i.c.l.e than the Intestine. If the Caul be corrupted, it must be cut to the sound Part, and the Wound is to be dress'd with Pledgets, Bolsters, and the Bandage _Spica_; as in the _Bubonocele_.

CHAP. XIV.

_Of the Operation of _Castration_._

The Mortification or the _Sarcocele_ of the t.e.s.t.i.c.l.es, gives occasion to this Operation; to perform which, the Patient must be laid upon his Back, with his b.u.t.tocks higher than his Head, his Legs being kept open, and the Skin of the _s.c.r.o.t.u.m_ taken up, one end of which is to be held by a Servant, and the other by the Surgeon, who having made a longitudinal Incision therein, or from the top to the bottom, slips off the Flesh of the _Dartos_ which covers the t.e.s.t.i.c.l.e, binds up the Vessels that lie between the Rings and the Tumour, and cuts 'em off a Fingers breadth beneath the Ligature: But care must be taken to avoid tying the Spermatick Vessels too hard, for fear of a Convulsion, and {239} to let one end of the Thread pa.s.s without the Wound. If an Excrescence of Flesh stick to the t.e.s.t.i.c.l.e, and it be moveable or loose, it is requisite to take it off neatly, leaving a small Piece of it on the t.e.s.t.i.c.l.e; and if any considerable Vessels appear in the Tumour, they must be bound before they are cut.

_The Dressing and Bandage._

The Dressing is made with Pledgets and Bolsters laid upon the _s.c.r.o.t.u.m_; and the proper Bandage is the _Suspensor_ of the _s.c.r.o.t.u.m_, which hath four Heads or Ends, of which the upper serve as a Cincture or Girdle; and the lower pa.s.sing between the Thighs, and fasten'd behind to the Cincture.

There is also another Bandage of the _s.c.r.o.t.u.m_, having in like manner four Heads, of which the upper const.i.tute the Cincture; but it is slit at the bottom, and hath no Seams; the lower Heads crossing one another, to pa.s.s between the Thighs, and to be join'd to the Cincture. Both these sorts of Bandages have a Hole to give Pa.s.sage to the Yard.

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CHAP. XV.

_Of the Operation of the Stone in the_ Ureter.

If the Stone be stopt at the _Sphincter_ of the Bladder, it ought to be thrust back with a Probe: If it stick at the end of the _Glans_, it may be press'd to let it out; and if it cannot come forth, a small Incision may be made in the opening of the _Glans_ on its side.

But if the Stone be remote from the _Glans_, it is requisite to make an Incision into the _Ureter_; to which purpose, the Surgeon having caus'd the Skin to be drawn upward, holds the Yard between two Fingers, making a Longitudinal Incision on its side upon the Stone, which must be prest between the Fingers to cause it to fly out; or else it may be taken out with an _Extractor_. Then if the Incision were very small, the Skin needs only to be let go, and it will heal of it self; but if it were large, a small Leaden Pipe is to be put into the _Ureter_, lest it shou'd be altogether clos'd up by the Scar: It is also expedient to anoint the Pipe with some Desiccative Medicine, and to dress the Wound with Balsam.

Afterward a little Linnen-Bag or Case is to be made, in which the Yard is to be put, to keep on the Dressing; but it must be pierc'd at the end, for the convenience of making Water, having two Bands at the other end, which are ty'd round about the Waste.

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CHAP. XVI.

_Of the Operation of _Lithotomy_._

This Operation is undertaken when it is certainly known that there is a Stone in the Bladder; to be a.s.sur'd of which, it may not be improper to introduce a Finger into the _a.n.u.s_ near the _Os Pubis_, by which means the Stone is sometimes felt, if there be any: The Finger is likewise usually put into the _a.n.u.s_ of young Virgins, and into the _v.a.g.i.n.a Uteri_ of Women, for the same purpose. But it is more expedient to make use of the Probe, anointed with Grease, after this manner: The Patient being laid on his Back, the Operator holds the Yard streight upward, the _Glans_ lying open between his Thumb and Fore-finger; then holding the Probe with his Right-hand on the side of the Rings, he guides it into the Yard, and when it is enter'd, turns the Handle toward the _p.u.b.es_, drawing out the Yard a little, to the end that the Ca.n.a.l of the _Ureter_ may lie streight. If it be perceiv'd that the Probe hath not as yet pa.s.s'd into the Bladder, a Finger is to be put into the _a.n.u.s_, to conduct it thither. Afterward in order to know whether a Stone be lodg'd in the Bladder, the Probe ought to be shaken a little therein, first on the Right-side, and then on the Left; and if a small Noise be heard, it may be concluded for certain that there is a Stone: But if it be judg'd that the {242} Stone swims in the Bladder, so that it cannot be felt, the Patient must be oblig'd to make Water with a hollow Probe.

Another manner of searching may be practis'd thus: Let the Yard be rais'd upward, inclining a little to the side of the Belly; let the Rings of the Probe be turn'd upon the Belly, and the end on the side of the _a.n.u.s_; and then let this Instrument be introduc'd, shaking it a little on both sides, to discover the Stone.

In order to perform the Operation of Lithotomy, the Patient must be laid along upon a Table of a convenient height, so as that the Surgeon may go about his Work standing; the Patient's Back must also lean upon the Back of a Chair laid down, and trimm'd with Linnen-Cloth, lest it shou'd hurt his Body; his Legs must be kept asunder, and the Soles of his Feet on the sides of the Table, whilst a Man gets up behind him to hold his Shoulders: His Arms and Legs must be also bound with Straps or Bands. Then a channell'd Probe being put up into the Bladder, a Servant standing upon the Table on the side of the Chair, holds the Back of the Instrument between his two Fore-fingers on that Part of the _Perinaeum_ where the Incision ought to be begun, which is to be made between his Fingers with a sharp Knife that cuts on both sides: The Incision may be three or four Fingers breadth on the left side of the _Raphe_ or Suture: But in Children its length must not exceed two Fingers breadth. If the Incision were too little to give Pa.s.sage to the Stone, it wou'd be more expedient to enlarge it than to stretch the Wound {243} with the Dilatators. When the Convex Part where the channelling of the Probe lies, shall be well laid open, the Conductors may be slipt into the same Channelling, between which the _Forceps_ is to be put, having before taken away the Probe. Some Operators make use of a _Gorgeret_ or Introductor to that purpose, conveying the end of it into the Chanelling of the Probe; which is remov'd to introduce the _Forceps_ into the Bladder: And as soon as they are fixt therein, the Conductors or _Gorgeret_ must be likewise taken out. Afterward search being made for the Stone, it must be held fast, and drawn out of the Bladder: But if the Stone be long, and the Operator hath got hold thereof by the two Ends, he must endeavour to lay hold on it again by the Middle, to avoid the great scattering which wou'd happen in the Pa.s.sage. The Stones are also sometimes so large, that there is an absolute necessity of leaving 'em in the Bladder. Again, if the Stone sticks very close to the Bladder, the Extraction ought to be deferr'd for some time; and perhaps it may be loosen'd in the Suppuration. Lastly, when the Stone hath been taken out, an Extractor is usually introduc'd into the Bladder, to remove the Gravel, Fragments, and Clots of Blood.

After the Operation, the Patient is carry'd to his Bed, having before cover'd the Wound with a good Bolster; and if an Haemorrhage happens, it is to be stopt with Astringents. A Tent must also be put into the Wound, when it is suspected that some Stone or Gravel may as yet remain therein: But if it evidently appears that {244} there is none, the Wound may be dress'd with Pledgets, a Plaister, and a Bolster, of a Figure convenient for the Part. The Dressing may be staid with a Sling supported by a Scapulary; or else the Bandage of the double T. may be us'd, the manner of the Application of which we have shewn elsewhere. The Patient's Thighs must be drawn close to one another, and ty'd with a small Band, lest they shou'd be set asunder again.

The Operation of Lithotomy in Women is usually perform'd by the lesser Preparative, which is done by putting the Fore-finger and Middle-finger into the _v.a.g.i.n.a Uteri_, or into the _r.e.c.t.u.m_ in young Virgins, to draw the Stone to the Neck of the Bladder, and keep it steady, so that it may be taken out with a Hook, or other Instrument.

This Operation may also be effected in Women, almost in the same manner as in Men; for after having caus'd the Female Patient to be set in the same Posture or Situation as the Men are usually plac'd, according to the preceeding Description, the Conductors may be convey'd into the _Ureter_, to let in the _Forceps_ between 'em, with which the Stone may be drawn out: But if it be too thick, a small Incision is to be made in the Right and Left side of the _Ureter_.

The lesser Preparative was formerly us'd in the Lithotomy of Men, after this manner: The Finger was put into the _a.n.u.s_, to draw the Stone toward the _Perinaeum_; then an Incision was made upon the Stone on the side of the Suture, and it was taken out with an Instrument.

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CHAP. XVII.

_Of the Operation of the Puncture of the _Perinaeum_._

This Operation is necessary in a Suppression of Urine, where the Inflammation is so great, that the Probe cannot be introduc'd. Then an Incision is to be made with the Knife or Lancet, in the same Place where it is done in Lithotomy; and a small Tube or Pipe is to be put in the Bladder, till the Inflammation be remov'd.

CHAP. XVIII.

_Of the Operation of the _Fistula in Ano_._

Fistula's are callous Ulcers: If one of these happen in the Fundament, and is open on the outside, it may be cur'd thus: After the Patient hath been laid upon his Belly on the side of a Bed, with his Legs asunder, the Surgeon makes a small Incision with his Knife in the Orifice of the _Fistula_, in order to pa.s.s therein another small crooked Incision-Knife, at the end of which is a Pointed Stilet with a little Silver Head which covers it, to the end that it may enter without causing Pain. When the Surgeon hath convey'd his Knife into the {246} _Fistula_, having the Fore-finger of his Left-hand in the _a.n.u.s_ or Fundament, he pulls off its Head, holding the Handle with one Hand, and the Stilet that pierceth the _a.n.u.s_ with the other; and at last draws out the Instrument to cut the _Fistula_ entirely at one Stroke.

If the _Fistula_ hath an Opening into the Intestine, an Incision is to be made on the outside at the Bottom thereof, to open it in the Place where a small Tumour or Inflammation usually appears, or else in the Place where the Patient feels a Pain when it is touch'd. If the Tumour be remote from the _a.n.u.s_, it may be open'd with the Potential Cautery, to avoid a greater Inconvenience. After having thus laid open the very bottom, the little Incision-Knife and Stilet, with its Head, is to be pa.s.s'd therein, the end of the Stilet is to be drawn thro' the _a.n.u.s_, and the Flesh is to be cut all at once. But if the _Fistula_ be situated too far forward in the Fundament, the _Sphincter_ of the _a.n.u.s_ must not be entirely cut, otherwise the Excrements cannot be any longer retain'd. Lastly, when the _Fistula_ hath been treated after this manner, all its Sinuosities or Winding-Pa.s.sages ought likewise to be open'd, and the Wound being fill'd with thick Pledgets steept in some Anodyn, is to be cover'd with a Plaister and a Triangular Bolster; as also with the Bandage call'd the T.

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CHAP. XIX.

_Of the Suture or St.i.tching of a _Tendon_._

It is requisite to undertake this Operation when the Tendons are cut, and when they become very thick. If the Wound be heal'd, it must be open'd again to discover the Tendon, and the Part must be bended, to draw together again the ends of the Tendons. Then the Surgeon taking a flat, streight, and fine Needle, with a double waxed Thread, pa.s.seth it into a small Bolster, and makes a Knot at the end of the Thread, to be stopt upon the Bolster. Afterward he pierceth the Tendon from the outside to the inside, at a good distance, lest the Thread shou'd tear it, and proceeds to pa.s.s the Needle in like manner under the other end of the Tendon, upon which is laid a small Bolster, for the Thread to be ty'd in a Knot over it. Then he causeth the Extremities of the Tendons to lie a little one upon another, by bending the Part, and dresseth the Wound with some Balsam. It may not be improper here to observe, that Ointments are never to be apply'd to the Tendons, which wou'd cause 'em to putrifie, but altogether Spirituous Medicaments; and that the Part must be bound up, lest the Extension of it shou'd separate the Tendons.

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CHAP. XX.

_Of the _Caesarian_ Operation._

When a Woman cannot be deliver'd by the ordinary means, this bold and dangerous Operation hath been sometimes perform'd with good Success. The Woman being laid upon her Back, the Surgeon makes a Longitudinal Incision beneath the Navel, on the side of the White-Line, till the _Matrix_ appears, which he openeth, taking great care to avoid wounding the Child: Then he divides the Membranes with which it is wrapt up, separates the After-Burden from the _Matrix_, and takes out the Child. Lastly he washeth the Wound with warm Wine, and dispatcheth the _Gastroraphy_ or St.i.tching up of the Belly, without sowing the _Matrix_. After the Operation, Injections are to be made into the _Matrix_, to cause a Flux of Blood; and a pierc'd Pessary must be introduc'd into its Neck.