High Operation for the Stone. 45 



Mr. C. aged 20, the son of an officer of Slieerness dock -yard, 

 had laboured under symptoms of stone from his earliest infancy, 

 and was twice sounded between the age of five and six, by a dis- 

 tinguished surgeon in London, but who was unable to satisfy 

 himself of the presence of a calculus in the bladder. The patient 

 and his father informed me that throughout his whole life he had 

 never been able to retain his urine more than half an hour, night or 

 day ; the pain was occasionally so severe, also, in these frequent 

 acts of micturition, that his life had become burthensome to him ; 

 and before this act could be effected in childhood, they were some- 

 times under the necessity of placing him on his head. 



These symptoms continuing without any abatement, he con- 

 sulted me about three months ago, when, on passing the sound, a 

 calculus was discovered. Under these circumstances I determined 

 to perform the high operation, and indeed there seemed to be no 

 choice left; first, because I considered the stone to be too large 

 for extraction by the lateral operation ; and, secondly, because the 

 bladder could not bear distention, for it never had been distended 

 sufficiently with urine, to enable anyone to perform the lateral ope- 

 ration with safety to the patient, and satisfaction to the surgeon. 



The patient having been kept upon low diet for a month, his 

 bowels frequently acted upon by purgative medicines during that 

 period, and the bladder purposely made accustomed to the frequent 

 touch, and sometimes rather rough treatment with the staff, the 

 operation was performed on the ISth June, 1825, in the following 

 manner, and in the presence of Dr. Lewis and Mr. Malin, of the 

 army, and of Messrs. Brown, Cullen, and Keddell, surgeons, of 

 Sheerness. The patient being placed on a mattress upon a table 

 of ordinary height, with a pillow under his head ; rf the pelvis raised 

 considerably higher than his shoulders, with the view of removing 

 the peritoneum as far from the parts to be cut as possible, while 



birth the water had always dribbled from him ; the stone was small and sphe- 

 rical, and its external surface made up of spiculated crystals. 



I have added this note from your letter to me, with a view that all the ope- 

 rations of the kind which have come to my knowledge may be recorded 

 together. 



