578 LITHOTOMY. 



of the urethra, and also the neck of the bladder, become 

 slit open ; the latter in two places, in consequence of a 

 second cut being made in withdrawing the bistoury. The 

 opening made being considered of sufficient dimensions, the 

 operator introduces the forceps into the bladder, and seizes 

 the calculus, one hand being up the rectum, to aid him in 

 so doing. The forceps clasping the stone are now to be 

 withdrawn, but with gentleness ; and with a vacillating sort 

 of movement of the hand from side to side, in order more 

 easily to surmount any difficulties in the passage, and the 

 more effectually to avoid contusion or laceration. M. 

 Girard tells us, ' That the cut through the pelvic portion of 

 the urethra ought always to be made obliquely to one side ; 

 the operator should hold his bistoury in such a direction, 

 that its cutting edge be turned towards the angle of the 

 thigh. By this procedure we shall gain easier access to the 

 bladder ; and not only avoid wounding the rectum, but also 

 the artery of the bulb, as well as the bulb itself, and sus- 

 pensory ligaments of the penis.' The parts cut through in 

 the operation are, 1st, the fine thin skin of the perineum, 

 smooth externally, and marked with a raphe ; densely cel- 

 lular internally: 2ndly, adhering to the tissue, the faschial 

 covering, derived from the faschia superficialis abdominis, 

 which has here become fibrous : it forms the common en- 

 velope to the parts underneath, and is closely connected 

 with the corpus musculosum urethree : 3rdly, the corpus mus- 

 culosum urethra, that penniform band of fleshy fibres which 

 springs by two branches from the ischiatic tuberosities em- 

 bracing the sphincter ani, and concealing the arteries of the 

 bulb ; whence they unite, and proceed to envelope the 

 urethra : 4thly, the corpus spongiosum urethra!, the part 

 immediately covered by the muscular envelope, and which 

 here is bulbous. It is more particularly worthy our remark, 

 from two arteries penetrating the bulb, which come from 

 without the pelvis, ascending obliquely outward to reach 

 the part : 5thly, the suspensory ligaments of the penis, pur- 

 suing the course of, and adhering to, the tendinous union 

 of the erectores. An attention to the relative position of 

 these parts will demonstrate the advantages of the lateral 

 oblique incision over one made directly along the raphe : by 

 pursuing the latter, we necessarily cut through the sus- 



