LITHOTRITY. 87 



position, and size. A strong pair of forceps are then introduced, 

 and the stone grasped in such a way that its short diameter shall 

 engage in the wound, whence it is to be dehvered slowly and 

 gradually. 



If it be impossible to remove the stone through this opening, it 

 may be enlarged with care, on the same, or, if necessary, the other 

 side. After its removal, the finger must again be introduced, to see 

 if there is another stone. 



The bladder being freed from all calculus by the forceps or 

 syringe, a tube is introduced into the bladder through the wound, 

 by which the urine is to escape. The patient is then put to bed, 

 with the knees placed together. A small cup or saucer receives the 

 urine from the tube. Severe hemorrhage may result from a wound 

 of the bulb of the corpus spongiosum, or from cutting the urethro- 

 bulbar artery. If a ligature cannot be applied, it must be compressed 

 by the finger as long as may be necessary. 



There may also be a venous or arterial oozing, which is to be 

 arrested by removing the tube and cramming the wound with lint, 

 a catheter being introduced through the urethra. Should there be 

 no hemorrhage, the tube is to remain until the wound has granulated 

 around it, and the urine has commenced to flow from the urethra. 



Some prefer to open the bladder with a scalpel, having confidence 

 in their anatomical knowledge, and considering the gorget as a 

 clumsy instrument, a remnant of olden times. Others use a con- 

 cealed bistoury, cutting either upon one or both sides of the urethra. 

 Besides which are various instruments, modifications of the gorget, 

 and scalpels with beaks attached. 



In four or five weeks the wound is healed. 



The higli operation is performed by making an incision through 

 the linea alba, opening the bladder where it is not covered by peri- 

 toneum. This is only necessary where the stone is of enormous size, 

 the prostate diseased, or the space between the tuberosities of the 

 ischia contracted. 



Stone in ivomen, is much less frequent than in men, because the 

 renal calculus is more readily passed by the urethra. Should it 

 be retained, and increase in size, it may be removed by dilating the 

 urethra sufficiently, or by the lateral operation, making the incision 

 from the orifice of the urethra, and through the neck of the bladder. 

 Incontinence of urine is apt to follow. 



The recto-vesical operation consists in cutting into the bladder 

 from the rectum. 



LITHOTRITY. 



Lithotrity signifies the boring or drilling the stone, and has been 

 most successfully accomplished by Civiale. His instrument con- 

 sists of a straight canula containing a drill and three claws which 



