AND HIS DISEASES. 199 



ward and downward toward the angle of the thigh by the 

 side of the anus. The skin and superficial tissues being 

 divided, the finger is then placed in the wound, and by 

 gently pushing aside the muscles and dilating the opening 

 tdl the sound is felt with the finger ; the outer wound 

 should be sufficiently enlarged to admit of freedom of oper- 

 ation in the deeper incisions. A long scalpel is now passed 

 in till it meets the point of the finger on the sound, when 

 the urethra is carefully divided, the finger is kept in the in- 

 cision, while the bougie is withdrawn and a straight grooved 

 sound is passed in through the outer opening direct into the 

 bladder, which should strike the stone at once. A long 

 straight bistoury should now be passed in along the groove 

 of the director, which divides the urethra and prostatic por- 

 tion of the bladder, being careful not to wound the pudic 

 artery, or injure the bowel ; the cutting edge should be 

 directed outward and downward in the same direction as 

 the outer incision. The forceps are now introduced, directed 

 by the finger till they come in contact with the stone, when, 

 assisted with one hand in the rectum, the stone is seized in 

 the blades, and turning it round to see that it is not attached 

 to the bladder, it is carefully removed by a sort of vacillating 

 motion. At this stage there must be no hurry or excite- 

 ment, otherwise the stone is apt to be crushed ; any little 

 impediments must be carefully divided by the knife, and any 

 exio-encies must be met by the tact and judgment of the 

 operator. The debris must now be washed out with water 

 or removed by the scoop ; if much oozing of blood continue, 

 cold water must be freely applied ; any vessels of importance 

 must be taken up and tied, which is often difiicult to do. 

 One or two stitches may be put on the upper third of the 

 wound, leaving it entirely open below ; he may now be re- 

 leased and led to his box, where he should be made comfort- 



