LITHOTOMY. 



cor:trived to fupport the fcrotum. Edinb. Med. and Surg. 

 Journal, vol. iv. 



Mr. Allan . Burns' method. — The plan introduced by 

 Chefesden, and revived by Mr. John Bell, is that whicii Mr. 

 A. Burns would afTume as the bafis ef the operation ; but 

 with it he propofes to blend Mr. Deafe's mode. 



" For more than twelve months," fays Mr; Burns, " I 

 liave been in the habit of (hewing fuch an operation, which 

 is as fiir.ple in its performance as the one in general ufe, is 

 attended with lefs danfrer to the patient, permits of an inci- 

 fion varying in fize according to the wifli of the operator, 

 and completely prevents injury of the reclum or pudic 

 artery. To perform this operation, I introduce into the 

 nrethra a common curved ftaff, then make the ufual incifion 

 into the perineum, divide fully and freely the levator ani, fo 

 as to expofe the whole extent of the membranous part of the 

 urethra, the complete extent of the prcllate gland, apd a 

 portion of the fide of the neck of the bladder. When this 

 part of the operation is finiflied, I open the membranous 

 part of the urethra, and introduce, through the flit, a ftraight 

 or female ftaff, with which 1 feel the ftone, and then with- 

 draw the curved ftaff. Next I feel beyond the proftate for 

 the inftrument, and then perforate the coats of the bladder 

 with a curved knife, the point of which is to be inferted in 

 the groove of the ftaff. This done, I grafp the handle of 

 the ltaf7 firmly in my left hand, and with the right lay ho'd 

 of the handle of the knife. Having afcertained that the two 

 inttruments are in fair contatt, I re!t the one hand upon the 

 other, preffing them together, and then, by a fteady ex- 

 trad^ion, I pull out the knife and ftaff together, which is 

 preferable to drawing the knife along the ftaff: it prevents 

 the rifle of the one Qipping from the other ; it guards the 

 bulb of the urethra, and every other part from injury ; for, 

 between them and the cutting inftrument the ilaff is inter- 

 poled. In the introduction of the knife, however, fome 

 caution is neceffary, and a clear knowledge of the relative 

 fituation of the parts in the pelvis is requifuc ; but this in- 

 formation is equally neceftary in operating with tke gorget. 

 When introducing the knife, the fide of the blade niuft be 

 laid flat along the fore-iinger of the ri^ht hand, which is to 

 project a little beyond the point. In this ftate, the finger 

 and knife are to be entered into the wound, oppofite the 

 tuber ifchii ; but, in proportion as they pafs along, they 

 are to be inclined forward, till at laft, with the point of the 

 finjer, the ftaff be felt throuah the coats of the bladder, a 

 little beyond the proftate, and rather higher than the orifice 

 of the urethra. Here the knife is, with the finger, to be 

 pu filed tiirough the bladder; and when the point is fairly 

 fixed in the groove of the ftaff, the operation is to be finifhcd 

 by the fteady extraction of both intlriiments. In operating 

 with the gorget, it is neceffary that the bladder be more or 

 lefs diftended ; a circuiiiflance, in fome cafes, with difficulty 

 accomplilhed, from th? irritability of this vifcus. In 

 operating with the knife, the parts can be as fafely cut 

 when the bladder is empty as when fiUl ; indeed, perhaps, 

 with greater fafety : for, when not dilated, the llioulder of 

 this vifcus can more eakly bo pufned in, fo as to permit the 

 finger to reach the ftaff". Some have imagined, that the in- 

 troduiSion of the point of the knife into the cavity of the 

 bladder mnft be dangerous, inafmuch as we are liable to 

 wound the tides, in fearching for the groove of the ftaff. 

 This objection is the refult of an inaccurate knowledge of 

 the ftate of the parts : for, in faft, we never grope in the 

 bladder with the point of the knife ; but, with the finger, 

 pufii in the fide of this vilcus into clofe contact with the ItafF, 

 into the groove of which the knife enters, as foon as it has 

 paffed through the coats of the bladder. Others again have 



objefted to this mode of operating, on the idea of its beiii? 

 more tedious in performance than with the gorget. This ia 

 alfo founded on a miftaken notion. True it is, indeed, that 

 were a furgeon, who has been much in the habit of operating'- 

 with the gorget, to exchant>e it for the knife, he would un*^ 

 doubtedly be longer of performing the operation in the latter 

 way : but the fame does not hold good refpecting thofe 

 who lia^;e never before operated in either mode. From all 

 that I have feen, I would fay, that the one operation may 

 be as expedi'ioufly performed as the other: but even ad- 

 mitting that the operation with the knife uniformly required 

 a little longer time, ftiU I think that, if fafer, it ought to 

 have the preference." Edinb. Med. and Surg. Journal, 

 vol. iv. p. Q^ — 67, 



The inftruments, ufed by Mr. Burns, are reprefented in 

 the furgical plates of this Cyclopedia. 



We (liall merely fay, that we think that the above plan 

 of operating is much better then the common mode of cut- 

 ting for the ftone with a gorget ; nor can it be found fault 

 with on the ground of difficulty. Notwithftanding its 

 merit, however, few feem difpofed to give it a fair trial ; 

 but coiitinue the employment of that dangerous and infuf- 

 ficient inftrument, the gorget, as much as ever. 



Oflithciomy, as performed ivtlh common Jcalpds, and fome 

 other kinds of knh-es. — The fa6t of Ciiefelden having cut for 

 the ftone fifty-two patients in fucceflion, of whom all re- 

 covered, excepting two, is an invincible argument in favour 

 of his method of operating. It may be expected, that v.e 

 ftiould defcrihe the mode of executing the operation with 

 a fcalpel ; but after the full account which we have deli- 

 vered of Chefelden's plan, this duty in reality becomes fu- 

 perfluous. The few judicious furgeons of the prelent day, 

 V.I10 have given the preference to the common fcalpel, have 

 all operated either after Chefelden's fecond or thud man- 

 ner. The laft has been chofen by Mr. .lohn Bell, and is 

 that which was crowned with luch matchlefs fuccefs in the 

 practice of its inventor. The lateral operation, as thus 

 executed by Chefelden, was truly once the price of EngUlli 

 furgery, to ufe an exprefGon of that able pnieflor. Dr. J. 

 Thomfou of Edinburgh. Other operators have preferred 

 operating after the manner of Chefelden's fecond irethod, 

 v'fz. by cutting from the urethra towards the bladder. 



Mr. Cliarles Bell has propofed the employment of a ftaff, 

 the groove of which, towards the extremity of the inftru- 

 ment, runs along its right fide or edge. Operative Sur- 

 gery, vol. i. 



It would be a tedious and endlefs bufinefs to defcribe all 

 the various knives which different furgeons have fuefefted 

 for lithotomy. The late Mr. Hunter had a particular one. 

 Mr. Aftley Cooper has ufed a knife, much refcmbhntr a 

 common diffedting fcalpel, but having a beak, by wiuch 

 it may be guided along the groove of the ftaff. AVc hear 

 that this diftinguiflied furgeon is now trying Frere Come's 

 lithotome cache. A much approved knife for lithotomy 

 was fome time fince invented by Mr. Gibibn, and another 

 by Mr. T. Bhzard. Engravings of all thefe will be found 

 in the furgical plates of tiiis work. Our objection to thefe 

 beaked knives is, that they are in reality gorgets. 



Of lithotomy on Women. — Women fuffcr much lefs from the 

 ft^one than men, and far lefs frequently ftand in need of 

 this operation. It is not, however, that their urine will 

 not fo eafily produce the concretions, which are termed 

 urinary calculi. The reafon is altogether owing to the 

 fhortnefs, largenefs, and very dilatable n:\ture of the fe- 

 male urethra ; circumflances, which in general render the 

 expulfion of the ftone with the urine almoft a matter of 

 certaini,y. The records of furgery prefent us with numerous 

 Z 3 inflances. 



