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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n, theHorwitz perineal staffbeing substituted forthe guide used in theoriginal operation, andsome radical changesbeing made in the tech-nic, tending greatly tosimplify the procedureby enabling the oper-ator to locate the ure-thra with absolute cer-tainty and without lossof time; by followingthe details of the fur-ther manipulation sug-gested the proximalportion of the canal canbe found without diffi-culty and the continuity of the urethra easily re-established. This method isalso applicable to cases of rupture of the urethra with extravasation of urine.The Horwitz dilating staff to be used as a substitute for the Wheelhouseinstrument has been fully described on p. 571. The latter is a long, narrowstaff with a shallow groove on the under surface and a slight hook on theend; when inserted, this instrument fails to render the urethra prominentor to hold it steady, so that in dissecting down upon the instrument it isfrequently difficult, in a deep perineum, to locate the canal; hence when
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Fig. 297.—Wheelhouses External Urethrotomy. 574 SURGERY OF THE PENIS AND URETHRA, an effort is made to incise the urethra, the mucous coat of the canal rollsaway from the point of the knife, and the blade incises the tissue on eachside of the guide without opening the urethra; moreover, when the canalis once opened, the small hook on the end fails to hold the upper edge ofthe incision and constantly slips away, so that the canal must againbe sought for. Finally, the staff in the perineal wound is constantlyin the operators way, interfering with further manipulations. The Hor-

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