Identifier: practiceofsurger00mumf (find matches)
Title: The practice of surgery
Year: 1910 (1910s)
Authors: Mumford, James Gregory, 1863-1914
Subjects: Surgery
Publisher: Philadelphia and London, W. B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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lapaxy; crushing the stone (diagrammatic). through the urethra, and to wash out the fragments. This last procedureis known as litholapaxy. Litholapaxy.—Jean Civiale, in 1824, was the first successfully to per-form the operation of crushing a stone.^ He did not wash out the frag-ments but left the patient to pass them. Many experimenters worked 1 Lithotrity: crushing a stone. Litholapaxy: lithotrity followed by promptremoval of fragments of the stone through a tube, by suction. STONE IN THE BLADDER 401 to perfect a better tcchnic, until Henry J. Bigelow, in the last quarterof the nineteenth century, developed the modern operation, crushingand evacuating at a single sitting—litholapaxy. For the generalsurgeon, and with suitable cases, litholapaxy is the operation of choice.The tcchnic of this procedure was graphically described by Bigelow ina brilliant series of articles published in 1878 and subsequent years.The instruments required are lithotrites of various sizes, and an evacuat-
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Fig. 245.—Diagram showing Bigelows evacuator in place. ing apparatus, such as is pictured in the text. Patients wdth im-permeable stricture, with extremely hard calculi, wdth encysted stone, orwith great prostatic enlargement, are not fit subjects for litholapaxy.In no case should the operation be performed hastily. The patientshould be kept in bed for five or six days previously, on a limited diet,with abundant drinking of water and of milk, and any existing cystitisshould be treated by urotropin and irrigation. Indeed, litholapaxyshould not be undertaken in the face of an active cystitis. On the 26 402 GENITO-URIXARY ORGANS operating table the patient should be tipped u)) in a modified Trendelen-burg position, the urethra and bladder should be thoroughly irrigated,while 6 or S ounces of boric-acid solution (4 per cent.) should beleft in the bladder. We are now ready for the actual crushing. Thesurgeon introduces a lithotrite, of the Bigelow or Forbes pattern, lettingit glide gentl

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