By Jas. B. MacAlpine

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Extra resources for Cystoscopy. A Theoretical and Practical Handbook Containing Chapters on Separate Renal Function and Pyelography

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_ E l l i p s e Gffieldof view cut off owing tion involves greater delicacy to bend in the telescope. and malleability. Bending of the telescope is therefore a frequent accident. Very slight distortion will be quite sufficient to cut off a large portion of the field in so long and narrow an optical system. The appearance seen in Fig. 31 results from a slightly deflected telescope. The dimly illuminated crescent owes its existence to rays of light reflected from the lateral wall of the tube. A slightly damaged telescope can be used temporarily, as a portion of the field still remains.

The schema on page 32 sets out the principal investigations required in an average urinary case, together with their order and spacing. It shows the routine adopted in my own hospital clinic, and can be recommended as a basis from which other schemes may be evolved to fit the special requirements of other hospitals. A glance at it will show that the investigation is so arranged as to occupy three visits to the Outpatients ' Department, and the object of each visit is indicated. —Once a week an outpatients' session is taken to which fresh cases are referred and at which old cases and late operation cases can also be seen.

Local anaesthesia, though capable of controlling pain arising in the mucosa of the bladder, is useless for that originating in the muscle, or indeed for the pain caused by the distortion of the deep urethra in the male. These being the two most prominent causes of discomfort in cystoscopy, the writer has abandoned local in favour of sacral anaesthesia for men, and has used it almost continuously in the Outpatients' Department for several years. As it has proved itself very valuable, and as its technique is not so well known as that of the other varieties of anaesthesia, a short description is thought desirable.

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