VOL XXXV.] PHILOSOPHICAL TRANSACTIONS. 201 



Arisw. That many patients offer, both young and old, who are afflicted with 

 the stone in the bladder, whom we cannot, with much hope of success, advise 

 to submit to the great operations for the stone, daily experience shows. It is 

 inhuman to cut them, and it shows a very great imperfection in our art, to say 

 we can give them no relief. Is there no medium yet found out between living 

 in extreme misery, and submitting to a desperate operation } Yes, Thomas 

 Fien6s, about 125 years ago, proposed a palliative cure for such patients, where 

 a radicative cure could not be expected; an operation which may be performed 

 with safety on the oldest, the wound being so small, and the parts cut of so 

 little consequence to life; an operation by which we can prevent or alleviate the 

 most lamentable effects of the stone; yet it has been as little attended to as 

 yet by the Hospital Lithotomists as Rosset's most excellent treatise, before Mr. 

 Douglas introduced the hypogastric section in 17 IQ. Though he admires 

 Fienus's design in making this fistula, yet he cannot by any means approve of 

 his way of doing it. 



It should be performed thus: place the patient as in Marianus's operation; 

 pass a staff into the bladder, then cut the skin and fat till you lay that part of the 

 urethra bare, which reaches from the prostate gland to the cavernous urethra; 

 then make a small incision into it with the point of the knife; then withdraw 

 the staff, and pass a small flexible canula into the wound of the urethra; then 

 dress the wound s. a. extract the canula, clean it and introduce it again every 

 dressing, that so you may leave a fistula in the room of the wound. 



Through this fistula the patient himself, or any one about him, may easily 

 pass an oiled probe, and push the stone back whenever he finds himself attacked 

 with a suppression of urine, or when the stone presses hard against the sphincter 

 on endeavouring to make water, which otherwise could not be done without 

 the ceremony of sending for, and staying in misery till a surgeon comes to pass 

 the catheter, which in such cases is not always to be done, without a great deal 

 of pain, and sometimes danger. By this fistula we can also very easily inject 

 any liquor, that may be thought proper either to prevent or allay the inflam- 

 mation of the bladder, or cleanse it from the gravel, or any other sort of 

 filth that may collect there, by which the increase of the stone will be pre- 

 vented, &c. 



In females all those advantages are obtained by the natural straightness and 

 shortness of the urethra, whence they never suffer the tenth part that males 

 do, which is an incontestable evidence that when the passage into the bladders 

 of males is made as straight and near as short, as is done by the forementioned 

 fistula, they will reap the same advantages by it. 



Therefore artificial fistulas in the perinaeum ought to be made for those 



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