238 PHILOSOPHICAL TRANSACTIONS. [aNNO 1746. 



Of an operation made by the high Apparatus, according to M. le Cat's Method 

 in the Year 1743. By Claud. Nic. le Cat, M.D., F.R.S. Translated from 

 the French by Philip Henry Zollman, F. R. S. N''480, p. 175. 

 Joseph Bunel, 12 years of age, was afflicted with the stone for 8 or g years 

 past. May 17, 1743, being the day appointed to cut him, he prepared to do 

 it by the lateral apparatus, which is the common method. At 5 in the morning 

 the patient was placed in the usual manner for the operation ; and endeavouring 

 to enter the probe, in order to cut him laterally, M. le C. found the stone so 

 large, or at least so far advanced in the neck of the bladder, that he had all the 

 trouble in the world to make the instrument enter; nor could he effect it, other- 

 wise than by thrusting it quite on the side. He put his finger into the anus, 

 and was convinced of the reality of the circumstances which the probe had made 

 appear : he immediately thought that the situation of this stone in the neck of 

 the bladder would hinder him from bringing the instruments freely to it ; that as 

 this hard body seemed exactly to fill the bladder, it would be impossible to intro- 

 duce a pair of pincers between it and the inside of the bladder; that its bulk 

 being too considerable, it would cause a mortal laceration by the low apparatus; 

 and lastly, that the patient was in such a case of necessity, as required to have 

 recourse to the high apparatus. 



Not having suspected all these particular circumstances, and not being much 

 inclined to make an operation in town, which he had as yet made but once, he 

 had not brought his instruments for cutting by the high apparatus ; but seeing 

 it would be a rashness in this case to perform the lateral operation, and not to 

 prefer the high apparatus to it, contrary to all his experiments and principles, he 

 put off the operation to the next day, and sent to Rouen for instruments for 

 cutting by the high apparatus. 



That day at noon he gave the patient a very light soup. Next day, the 18th, 

 he cut him by the high apparatus at 8 in the morning. The patient was placed 

 on one of those little beds which the turners make for the country people ; the 

 2 extremities of the bed were raised, especially that which was to support the 

 thighs, and the middle was hollow; the whole covered with alaizes.* 



The patient's head was towards the light , his hands and feet were tied across 

 the bed, in the places where they came to lie, when the patient was laid on his 

 back ; his legs were stretched and open ; his arms bi'ought down below his 

 hips ; in short, he was in a very convenient posture. M. le Cat was on the right 

 side of the patient. 



In this manner he thrusted an algalie (or hollow catheter) into the bladder, 

 introducing it on the side, as he had done the day before. He injected a syringe- 



• These are cloths folded several times, and laid under the patients, to keep them cleanly. — Orig. 



