High Operation for the Stone. 4? 



the opening in the bladder might be enlarged accordingly. Hav- 

 ing satisfied myself on this head, I hooked up the fundus of the 

 bladder with my finger, and enlarged the incision towards its 

 cervix, sufficiently to admit of the free extraction of the stone. 

 Some little difficulty here arose in disengaging the stone from its 

 situation, notwithstanding the great assistance obtained by the 

 introduction of the fore-finger of my right hand into the rectum, 

 while the fore-finger of my left was in the bladder to cant or turn 

 the stone, so as to extract it by its smaller axis ; and, indeed, this 

 was not effected until the single blade of a pair of small stone 

 forceps was introduced. The stone being thus turned, it was 

 easily removed with the finger and thumb. In point of fact, so 

 firmly did the bladder grasp the calculus, that the idea was con- 

 veyed to our mind of its actual adhesion to the coats of that 

 viscus. 



One small cuticular artery was divided at the first incision, and 

 secured at the time, to prevent the future steps of the operation 

 being obscured by the bleeding, and the subsequent issue of blood 

 into the cavity of the pelvis. 



Two slips of linen, dipped in oil, were introduced through the 

 external wound on each side of the bladder, but not into the bladder , 

 as was done in your first case, published in the Philosophical 

 Transactions * ; a gum elastic catheter was passed into the bladder 

 so as just to enter its cavity, and no farther, and was secured 

 in this situation by tapes attached to the instrument, and to 

 an elastic band, or retainer, in the manner described in your 

 paper, but which in this case was made of flannel, lined with 

 calico. The sides of the wound were brought together by 

 slips of sticking plaster, and the parts supported by a flannel 

 roller, passed three or four times round the pelvis and the lower 

 part of the abdomen. The patient, by means of pillows, was 

 placed on an inclined plane, a vessel was secured to the end of 

 the catheter to receive the urine, and he had an anodyne draught 

 administered to him. 



• Afterwards republished in your third vol. of Strictures. 



