Identifier: operativegynecol001kell (find matches)
Title: Operative gynecology :
Year: 1906 (1900s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943
Subjects: Gynecology Gynecology Gynecologic Surgical Procedures
Publisher: New York and London : D. Appleton and company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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ystitis, where almost the entire bladder is involved,and where there are areas of ulceration, I find it is best to begin the treatment 460 AFFECTIONS OF THE URETHRA AND BLADDER. by draining the bladder for some weeks, and by keeping the patient for severalhours daily in a tub of warm water at a temperature of about 38° to 39° C.(100° to 102° F.). When the patient is sufficiently prepared for operationthe bladder is emptied and she is put into the knee-chest position. A catheteris next introduced, allowing the air to rush in and stretch the bladder to amaximum. An assistant then lifts up the posterior vaginal wall so as toexpose the stretched anterior vaginal wall with the cervix uteri at maximumdistance. The operator then takes in hand the knife attached at an angleto a handle which is also bent, as shown in the figure. He plunges thisknife through the vesico-vaginal septum in the median line, at a point about1^ cm. in front of the cervix (see Fig. 274). In this way the bladder is
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Fig. 274.—Rapid and Safe Method of Opening the Base of the Bladder. The patient is in the knee-chest posture. A speculum is introduced to admit air into the bladder.The air-distended organ is then opened in the manner seen in the figure to the extent indicated at a. opened, and, by drawing the knife down toward the urethra, the incision ismade any length which may be desired. By putting the finger in the incisioninto the bladder, the internal orifice of the urethra is located and the knifesafely guided as far forward as it is desirable to cut. The operation may bedone without any anesthetic at all, or by injecting a weak solution of cocaininto the vesico-vaginal septum. There may be little or no bleeding attendanton it, on account of the posture of the patient. When it is desirable to securedrainage for a short time in a dependent position, and also in cases of irritable TUBERCULAR CYSTITIS. 461 urethra, I plunge the knife through the septum into the air-distended bladder,midway bet

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