202 PHILOSOPHICAL TRANSACTIONS. [aNN0 1727. 



who, by reason of their great age, and bad habit of body, &c. cannot undergo 

 any of the great operations for the stone, with the hopes of success. 



Quest. II. Whether it be not possible to dilate the artificial fistula in the 

 perinaeum of males, and the urethra of females, with sponge or gentian tents, 

 gradually increased for some time to such a width, that we may easily pass a 

 pair of forceps into the bladder, with which the stone when small may be 

 extracted, and when large, or of an irregular figure, broken, and the pieces 

 extracted gradually and at different times, when they cannot be extracted at 

 once, without fatiguing the patient too much ? 



^nsw. To prove that both these fistulas may be dilated to a sufficient size by 

 the means proposed, especially if the parts are frequently bathed in a semicu- 

 pium or otherwise, as the operator shall think proper, and some warm oil in- 

 jected into the fistula every time the tent is changed, the better to supple and 

 relax the parts, Mr. D. makes use of three arguments, viz. one from common 

 experience in analogous cases; another from the operations of nature on the 

 same parts; and the third from instances of this operation being performed after 

 the method proposed. 1st, Common experience shows to what a great width 

 fistulas in all other parts of the body, though very small at first, maybe dilated 

 by sponge or gentian tents. 



2d. Nature herself, without any art, has frequently performed this operation 

 on both sexes; in males who have been cut for the stone after the old way, and 

 had fistulas remained in perinaao. It is often found that some considerable time 

 afterwards, stones of no small size have appeared, which had made their way 

 through the sphincter of the bladder into the membranous urethra, and stuck 

 near the orifice of the fistula, whence they were easily and safely extracted. 

 Mr. D. saw a stone as large as a pullet's egg, that was expelled from the bladder 

 of a young woman without any help, and she had no inconveniency afterwards; 

 which certainly would have happened, had it been extracted after the common 

 violent method. In the last Phil. Trans. Dr. Beard, of Worcester, gives an 

 account of a yet larger stone, that passed after the same manner, but the patient 

 had the common inconveniency afterwards, viz. an incontinency of urine, which 

 was owing more to the roughness than the size of the stone, which had lace- 

 rated the parts as in the common operation, which might have been prevented 

 had she been assisted in time as above. 



3d. Mons. Collet, in his Traite de la Taille, gives an account of a gentleman 

 on whom he performed this operation three different times, and extracted in all 

 ten stones. And Mr. D. knew a gentleman keep a fistula in perinaeo open for 

 the very same reasons. 



Since then it is evident that fistulas in all parts of the body are dilatable to a 



