Lithotonty bi Women.—From the shortness, largeness, and very dilatable nature of the female urethra, the surgeon is seldom called upon to perform the operation in women. The formation of calculi is perhaps not leas common in women than in men ; but from the anatomical circumstances just alluded to, stones of considerable magni tude have been voided spontaneously. This fact Las suggested the plan of mechanically dilating the urethra, and thus extracting them without the employment of any cutting- instruments ; but where the stone is very large, the degree of dilatation necessary for its extraction is liable to produce paralysis of the pert, and incontinence of urine ever after. To avoid these evils, an artificial opening should be inade.into the bladder, The operation is simple : a straight staff, or director, is introduced through the meatus urinariva ; the groove is turned obliquely downwards and outwards, in a direction parallel to the ranina of the left os pubis ; and the knife is thus conducted into tho bladder, and makes the necessary incision through the whole extent of the passage and neck of the bladder.
Treatment after the Operation.—The dangers to be guarded against after an operation of lithotomy are, inflammation of the bladder and peritoneum ; infiltration of urine into the cellular texture of the peri neum and parts adjacent ; and hemorrhage. To prevent the dangers
that would arise from inflammation, the patient should be kept perfectly quiet, and on a low regimen ; but supposing it to have set in, the most prompt and energetic measures must be had recourse to ; venesection, the use of the warm bath and fomentations, with the administration of such medicines as are known to be most efficacious in such cases, afford the only chance of preserving the patient. Infiltration is to be avoided by placing the patient in such a position that the urine can flow readily from the wound, which should bo left uncovered, or this end is attained more effectually by introducing an elastic gum catheter into the bladder, and suffering it to remain there for the first two or three days. 'hemorrhage is fortunately a rare occurrence, but should this take place, pressure, made by means of sponge or lint compresses, may be tried ; and it this fail, the bleeding vessel must be sought for and tied.