Of the Extraction of the STONE in WOMEN.
THE Extraction of the Stone in Women, will easily be understood, since the whole Operation consists in placing them in the same Manner as Men, and without making any Wound, introducing into the Bladder a straight Director, upon that, a Gorget, and afterwards, the Forceps to take hold of the Stone; all which may be done without Difficulty, by reason of the Shortness of the Urethra. If, the Stone proves very large, and in extracting draws the Bladder forwards, 'tis adviseable to make an Incision through the Neck of it, upon the Stone, which not only will facilitate the Extraction, but also be less dangerous than a Laceration, which would necessarily follow. The Dressings are Fomentations and emollient Ointments, which should be applied two or three times a-day, and the Patient in other Respects be treated like Men who have undergone the Operation for the Stone.
A. A Sound used in searching for the Stone.
The Size represented here is but a little too large for the youngest Children, and may be used upon Boys till they are thirteen or fourteen Years of Age; a larger should be employed between that Age and Adultness, when one of about ten Inches in a right Line from the Handle to the Extremity, is proper. This should be made of Steel, and its Extremity be round and smooth.
B. A Staff fit for the Operation on Boys from eight to fourteen Years of Age. The Staff for a Man must be of the Size of the Sound I have already described.
C. A Staff something too big for the smallest Children, but may be used upon Boys from about four Years of Age to eight. The Staff has a Groove on its convex Side, which first serves as a Direction where to cut, and afterwards receiving the Beak of the Gorget, guides it readily into the Bladder. Care should be taken in making the Groove, that the Edges of it be smoothed down, so that they cannot wound in passing through the Urethra. The Extremity should also be open, otherwise it will be sometimes difficult to withdraw the Staff, when the Gorget is introduced, and presses against the End of it.
These Instruments are usually made with a greater Bending than I have here represented; but I think this Shape more like that of the Urethra, and rather more advantageous for making the Incision.
D. The Yoke, an Instrument to be worn by Men with an Incontinence of Urine: It is made with Iron, but for use must be covered with Velvet: It moves upon a joint at one End, and is fastened at the other by Catches at different Distances placed on a Spring, as will be easily understood by the annexed Print. It must be accommodated to the Size of the Penis, and be taken off whenever the Patient finds an Inclination to make Water. This Instrument is exceedingly useful, because it always answers the Purpose, and seldom galls the Part, after a few Days wearing.
The EXPLANAT ION.
A. A small Catheter made of Silver. This Instrument is hollow, and serves to draw off the Urine when under a Suppression: It is also used in the high Operation to fill the Bladder with Water: Near its Extremity, are two Orifices, through which the Water passes into its Cavity. Care should be taken that the Edges of these Orifices are quite smooth.
B. The Knife used in cutting for the Stone: It is the same I have already described; but I thought it might not be improper to repeat the Figure with the Alteration of a Quantity of Tow twisted round it, which makes it easier to hold when we perform the Lateral Operation, and turn the Edge upwards to wound the prostate Gland.
C. A Female Catheter, differing from the Male Catheter, it being almost straight, and something larger.
D. A Silver-wire to pass into either Catheter, for the removing any grumous Blood, or Matter that clogs them up.
A. The Gorget used upon Men in the Lateral Operation.
B. The Gorget used upon Children under five Years of Age in the Lateral Operation.
A Gorget between the Sizes of these two, will be fit for Boys from five Years of Age to fifteen or sixteen.
These Instruments are hollow for the Passage of the Forceps into the Bladder, and their Handles lie slanting, that they may the more readily be carried through the Wound of the Prostate, which is made obliquely on the left Side of it. The Beak at the Extremity of the Gorget, must be smaller than the Groove of the Staff which is cut upon, because it is to be received in the Groove. Care should be taken, that the Edges of the Gorget near the Beak are not sharp lest instead of dilating the Wound, as it ought, it should only cut on each Side when introduced; in which Case, it would be difficult to carry the Forceps into the Bladder.
C. A Gorget, with its Handle exactly in the Middle; this shaped Instrument is used in the old Way. All the Gorgets should be made of Steel.
A. The Forceps for extracting the Stone. These are represented a little open, that the Teeth may be better seen within-side.
This Instrument must be of different Sizes for different Ages and Stones, from the Length of that in the Copper-plate, to one of near a Foot long; but the Forceps of about eight Inches long will be found most generally useful. The number necessary to be furnished with, will be four or five.
Great care should be taken by the Makers of this Instrument, that it move easily upon the Rivet, that the Extremity of the Chops do not meet when they are shut, and particularly that the Teeth be not too large, lest in entering deep into the Stone they should break it: It is of consequence also that the Teeth do not reach farther towards the joint than I have here represented, because a small Stone, when received into that Part, being held fast there, would dilate the Forceps excessively, and make the Extraction difficult; on which account, the Inside of the Blades near the joint should be smooth, that the Stone may slip towards the Teeth.
B. A Director made of Steel, used for the Direction of the Gorget, in the Extraction of the Stone from Women.
C. A. Scoop to take away the Stone when it is broken into small Pieces like Sand. This Instrument is made of Steel.