Excerpt from The Birmingham Medical Review, Vol. 24: A Monthly Journal of the Medical Sciences; July to December, 1888
Sir Henry Thompson has devised a special instrument of ivory for this scratching work, and it is of the greatest possible use.
The bladder must be thoroughly bared before it is opened. Its walls are unmistakeable to those who have once appreciated their peculiar appearance. The pale irregularly arranged cords of bladder muscle cannot easily be overlooked. Any large vein which is likely to be injured during the next stage of the operation is tied with two catgut ligatures, and divided between. The bladder is now caught at its highest part with a tenaculum, which is to be passed into the tissues until a trickle of ﬂuid by its side proves its entrance into the cavity. With the bladder held up firmly by the hook, a half-inch vertical incision is made downwards through its most presenting part; there is at once'an escape of ﬂuid. Each edge of this small wound is secured immediately by a silk thread, introduced from within outwards with an ordinary curved needle. These threads are looped, tied, and given into the hands of an assistant, and the tenaculum is now withdrawn. The loops serve the double purpose of holding the bladder wound open for further manipulation and of preventing the organ retracting out of sight behind the pubes when its ﬂuid contents have escaped. The tip of an index finger is introduced through the wound, and the size and locality of the stone determined. The opening is best enlarged by dilatation; the other index finger is introduced, and the stone, caught between the fingers held palm to palm, and withdrawn. A tighter hold may be taken by locking the fingers which are outside the bladder into each other. This is Thompson's suggestion, and it certainly answers better than either forceps or scoop. The objection that it necessitates a slightly larger opening has no real foundation. Care must be taken during extraction that no further disturbance of the cellular tissue in front of the bladder is made than is absolutely necessary.
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