SURGICAL OPERATIONS. 26.. 
advpted but in a case where the magnitude of the stone precludes 
its extraction through the neck of the bladder. In all other cases, 
lithotomy by the urethra is to be pursued. For -ts performance 
are required a straight probe-pointed bistoury, a whalebone fluted 
staff, and a pair of forceps, curved at the extremities. The ani- 
mal should, if practicable, be maintained in the erect posture. 
The tail plaited and carried round on the right quarter, the opera- 
tor feels for the end of the staff introduced up the urethra, and 
makes an incision directly upon it, from above downward, an inch 
and a half or two inches in length. Next, he introduces the sound, 
and passes it onward into the bladder. Now, placing the back of 
the bistoury within the groove of the sound, by gliding the knife 
forward, the pelvic portion of the urethra, and also the neck of the 
bladder, becomes 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 oper- 
ator introduces the forceps into the bladder, and seizes the calculus, 
one hand being up the rectum, to aid him in so doing. The for- 
ceps, clasping the stone, are now to be withdrawn, but with gen- 
tleness, and with a vacillating sort of movement of the hand 
from side to side, in order more easily to surcaount any difficulties 
in the passage, and the more effectually to avoid confusion or 
laceration. M. Girard tells us ‘that the cut through the pelvic 
portion of the urethra ought always to he made obliquely to one 
side. The operator should hold his bistoury in such a direction 
that its cutting edge be turned toward 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 suspensory ligaments of the penis. 
The parts cut through in the operation are, Ist, the fine thin 
skin of the perineum, smooth externaily, and marked with a 
raphe; densely cellular internally ; 2d, adhering to the tissue, the 
fascial covering, derived from the fascia superficialis abdominis, 
which has here become fibrous, it forms the common envelope to 
the parts underneath, and is closely connected with the corpus 
musculosum urethre ; 3d, the corpus musculosum urethre, that 
penniform band of fleshy fibers which springs by two branches 
from the ischiatic tuberosities embracing the sphincter ani, and 
concealing the arteries of the bulb, whence they unite, and pro- 
ceed to envelop the urethra; 4th, the corpus spongiosum urethre, 
