Identifier: marylandmedicalj4519medi (find matches)
Title: Maryland medical journal
Year: 1902 (1900s)
Authors: Medical and Chirurgical Faculty of the State of Maryland
Subjects: Medicine
Publisher: Baltimore : Manning and Ashby
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: The College of Physicians of Philadelphia and the National Endowment for the Humanities

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able to expect one single cautery blade to besuitable for all. An incision which is sufiiciently deep for a medium-sized hypertrophy may be wholly inadequate for a very large one,and positively dangerous for the small fibroid forms. Then, again,one lobe is often very greatly enlarged, while another is only slightlyso. Are we, then, to give each the same depth of cautery incision ?I have in my collection of autopsy specimens several prostates withsmall, but very obstructive, middle-lobe enlargements, where the MARYLAND MEDICAL JOURNAL april, 1902 ordinary Freudenberg and Bottini instruments would have pene-trated beyond the capsule, and perhaps into the rectum. It is very evident, then, that an instrument with several easilyinterchangeable blades of graded sizes would be a decided im-provement. There are two other defects in Freudenbergs apparatus which,. while apparently trivial, are of considerable importance. The firstis in the shape of the beak of the instrument as now constructed.
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Fia. 2. The traction necessary to hold the beak up against the prostate dur-ing an operation will often pull it into the urethra. This is due tothe fact that the beak meets the shaft at such a wide angle or atsuch a slope (see Fig. 4) that even moderate traction causes it toride over a median bar, for example, and slip into the prostaticurethra. The dangers of this accident are not small. Indeed, it hasoccurred several times, and has been responsible for several deaths,the cause being division of the membranous urethra, extravasation,hemorrhage, etc.

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