VOL. XXXII.J PHILOSOPHICAL TRANSACTIONS. 581 



out the stillet, and order the ligature assistant to cast the ligature, with a skein 

 of silk, round the penis, above the glans. Then fix the key to the head of 

 the catheter, to keep it steady, while you screw on the syringe; then screw the 

 second part of the sucking-pipe to the first. Then order the penis ligature to 

 be straightened, and the prepuce assistant to gather the prepuce up about the 

 catheter, and to hold it as close as possible. Order the water, being a little 

 warmer than milk, to be clapped under the sucking-pipe, then draw up the 

 water into the syringe, and thrust it into the bladder at leisure, and repeat it 

 till the bladder is so full that you can perceive its tumour through the abdomen, 

 at which time you will also observe the penis above, and the prepuce below the 

 ligature, very much swelled, and the patient in a great deal of pain, which is 

 a certain sign that there is enough injected; then withdraw the syringe and 

 catheter together, taking particular care that the penis assistants straighten their 

 gripe, lest the water should follow the catheter, which would undo all. 



2dly. In making the incision, which is done thus : order the penis assistants 

 to turn the penis towards the anus, that so their hands may be the more out of 

 the way ; then take the first knife, and cut at leisure, and with a steady hand, 

 from near the upper part of the tumour of the bladder, or lower, according to 

 the computed size of the stone, down to the os pubis, and exactly in the 

 middle; when you have got a little more than half way through the abdominal 

 muscles, take the second knife, clap its back on the middle of the os pubis, 

 then run its point down towards the sphincter, till you get into the cavity 

 of the bladder, which is discovered by the issuing out of the water; then run 

 the knife along very quickly towards the fund of the bladder, as far as is 

 necessary. 



3dly. In extracting the stone, which is done thus : before withdrawing the 

 knife, introduce the fore and middle fingers of your left hand, between the 

 knife and the os pubis, into the bladder ; then withdraw the knife, and thrust 

 the fore and middle fingers of your right hand into the anus, and raise the 

 stone up towards the wound, and so you will easily catch hold of it, though 

 ever so small, with your fingers which are in the bladder; then draw it 

 out with the smallest end foremost. Then introduce your fingers again, to 

 see if there are any more stones, which are to be drawn out as before. 



Then take a needle and thread, and make one stitch through the skin, 

 in the middle of the wound, and tie it pretty close, then undo the straps 

 and carry the patient to bed. 



The patient being put to bed, I laid a pledget armed with balsam over the 

 wound, and a bit of sticking plaster over that. Then embrocating all the 

 abdomen, scrotum and penis, with warm ol. chamasmel. I applied over the 



