Identifier: 101503039.nlm.nih.gov
Title: The practice of surgery
Year: 1853 (1850s)
Authors: Miller, James, 1812-1864 Sargent, F. W. (Fitzwilliam), 1820-1889
Subjects: Surgical Procedures, Operative
Publisher: Philadelphia : Blanchard and Lea
Contributing Library: U.S. National Library of Medicine
Digitizing Sponsor: Open Knowledge Commons, U.S. National Library of Medicine

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e rectum; and the sameassistant keeps the scrotum elevated. The surgeon, seated in front, atsuch a height as to bring his hand conveniently on a level with theperineum—and with all the instruments he is likely to require spreadon a towel or tray on the floor by his side, so as to be within easy reachwhen wanted—introduces his left forefinger into the rectum, to makesure of its being empty, and to stimulate it to contraction. The knife—longer than the common scalpel, especially in the handle, and withthe posterior two-thirds of the edge blunt—is then entered in theperineum—previously well shaved—about an inch in front of the anus,on the left side; and is carried downwards beyond the anus, passingabout midway between that orifice and the tuberosity of the ischium,through the skin, fat, and superficial fascia. The forefinger of the lefthand is then placed in the wound, and directed upwards and onwards;with the double object of keeping the bowel out of harms way, and Fig. 215.
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Plan of the Lateral Operation of Lithotomy. The knife entering the urethra. dilating the space—pushing aside areolar tissue, but not tearing mus-cular fibre. With the knifes edge, the fibres of the transverse muscleof the perineum—if it exist—are divided, along with such fibres of thelevator of the anus as resist the free onward passage of the finger. Thegroove of the staff is now sought for; and the finger is moved freely, soas to dilate the outward wound sufficiently—a touch of the knifes point 472 LITHOTOMY. being applied, warily, to any resisting part. Behind the triangularligament, and in front of the prostate, the finger-nail is lodged inthe groove; and over it the knifes point is made to perforate. Theknife, felt distinctly on the staff, is then pushed onwards in the groove,obliquely downwards and backwards ; so as to divide the portion of theurethra which intervenes between the point of the knifes entrance andthe prostate gland, and also the anterior part of the prosta

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