Identifier: surgeryitsprinci04keen (find matches)
Title: Surgery, its principles and practice
Year: 1906 (1900s)
Authors: Keen, William W. (William Williams), b. 1837 Da Costa, J. Chalmers (John Chalmers), 1863-1933, joint ed
Subjects: Surgery General Surgery
Publisher: Philadelphia and London : W. B. Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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d inthe urethra for a considerableperiod of time, the followingmethod may be employed toprevent it from slipping out ofthe canal. The instrument isinserted and fixed in place bymeans of a piece of tape so tiedthat the knot comes on theunder surface of the penis; thetwo ends of the tape are carriedaround the middle of the bodyof the organ, and knotted oncemore on the dorsum; the ends are then carried up and fastened to a band about the waist, which is heldin position by means of perineal straps (see Fig. 290). Anesthesia,—I believe that the high mortality following operationsfor the relief of chronic urinary olDstruction in patients advanced in years,with damaged kidneys, diseased heart, atheromatous degeneration of thecerebral vessels, and a history of one or more attacks of apoplexy,is due notso much to the operation itself, as to secondary shock, uremia, or sup-pression, the delayed effects of the anesthesia. In cases of stricture within the first inch of the urethra the operation
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Fig. 290.- Intermittent Drainage, ContinuousCatheterism. 552 SURGERY OF THE PENIS AND URETHRA. can be done under local anesthesia, one dram of a 2 per cent, solutionof cocain being injected into the urethra and retained in the canal forfiA^e minutes. Operations upon the deep urethra should be performed under generalanesthesia. If the kidneys are healthy, ether is preferable, but if they arediseased, chloroform should be administered. When the heart, arteries,and kidneys are diseased, I have frequently had A^ery good resultsfrom spinal anesthesia, using a combination of morphin and scopolamin. In elderly and debilitated subjects and in complicated cases the pa-tient should be instructed to drink large quantities of water for severaldays preceding the operation. The operation should be performed asrapidly as possible, and every precaution observed to protect the patientsfrom cold and drafts. On being returned to bed, a submammary injectionof 1000 c.c. of normal salt solution should be g

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