46 Mr. Hutchison on the 



his feet rested upon chairs ; standing on the right side of the pa- 

 tient, I made an incision, nearly four inches in length, with a 

 scalpel, in the line of the linea alba through the integuments 

 downwards over the front of the pubes, which latter step I found 

 of great advantage both during the operation and in the subse- 

 quent treatment of the case. The incision was carried on down 

 towards the bladder, between the pyramidales muscles, and 

 through the linea alba ; the latter being first punctured, and after- 

 wards cut transversely upon the symphysis pubis, dividing some of 

 the fibres of the pyramidal muscles on each side as we proceeded, 

 so as to give a more free passage for the extraction of the stone. I 

 then, with a director, detached this tense membrane (the linea alba) 

 from its subjacent adhesions, and divided it upwards with a probe- 

 pointed bistoury, introduced into the groove of the director, until I 

 could readily insert the forefinger of my left hand, which is, on all 

 occasions, the best director, and which was most conveniently done 

 by standing between the legs of the patient. "When about two 

 inches and a half of the linea alba were thus divided, I thought we 

 should have had sufficient space for cutting into the bladder and 

 extracting the stone ; but as the wound appeared deep and narrow, 

 and there Was a large calculus to extract, I cautiously extended the 

 incision half an inch more, in the manner already described. 



The bladder, very much contracted, was now clearly seen 

 covered by fat, and was raised through the fat, upwards and 

 forwards, to the external wound of the integuments upon the 

 point of a silver staff, with a groove in its concave part, extend- 

 ing from close to its point downwards about two inches, and 

 which I preferred to the sond used by the French surgeons, 

 that instrument appearing to me both unnecessary and unsci- 

 entific : the handle of the silver staff being held in a depressed 

 position by my friend Mr. Brown, the anterior part of the fun- 

 dus of the bladder was pierced from without, by a straight sharp- 

 pointed bistoury, passing its point into the groove of the staff, 

 and carrying the incision downwards and forwards to the 

 pubes, until there was room for the fore-finger, which was intro- 

 duced for the purpose of ascertaining the size of the calculus, that 



