A CASE OF LITHOTOMY. 
369 
direction of the original wound. I then introduced a pair of for- 
ceps along the staff into the bladder, when the latter was with- 
drawn, and, on expanding the forceps, I immediately grasped the 
end of the stone, and endeavoured to extract it in the axis of the 
pelvis and of the wound. In attempting this, I felt considerable 
difficulty, in consequence of the tumour formerly alluded to fall- 
ing before the clams of the forceps, and the stone so occupying 
the wound as to act like a valve in resisting their extraction. On 
increasing the force, a part of the stone gave way, and was re- 
moved in pieces in the blades of the forceps. Repeated attempts 
were made, in which the stone was always readily grasped, but 
the same difficulties were experienced in attempting its removal. 
The hand of an assistant was then introduced into the rectum, 
to endeavour to fix the stone more securely, and so as to enable 
the forceps to grasp it more completely ; but although, by this 
means, the stone was more securely grasped, still the same diffi- 
culties were opposed to its extraction. Finding such to be the 
case, I then endeavoured to crush the stone, and succeeded so 
far as to remove a considerable portion of one of its sides ; but it 
was found to be so hard, and its size so great, that to have per- 
severed in this would have subjected the animal to a more pro- 
tracted operation than I felt myself justified in doing. 
Causing the hand of the assistant to be removed from the rec- 
tum, I endeavoured to pass my right hand through the wound 
into the bladder, and, pushing aside the tumour, to endeavour 
to extract the stone with it, as if by a scoop. Finding that it 
was possible to be effected in this manner, but my hand, being- 
bulky, meeting with considerable resistance, Dr. Mercer, who was 
assisting me, observed this, and suggested that, as his hand was 
considerably smaller than mine, it would be more easily intro- 
duced : this, after a little care was effected, and his hand passed 
into the bladder. His fingers passed between it and the stone 
until he got them fairly beyond it, and had it hooked into the 
palm of his hand. After considerable force being used, he suc- 
ceeded in extracting it, but not without considerable difficulty, 
in consequence of the same opposition. 
As the surface of the stone had been considerably broken down 
by the repeated attempts to crush it, the bladder was carefully 
washed out with a syringeful of tepid water, and the pony was 
lifted down and unloosened. It immediately got up, and walked 
steadily, although a little exhausted, into a loose box. 
The blood lost during the operation would not exceed a quart, 
and which was entirely venous ; and the small quantity thus lost 
I attribute to the precaution of securing the pubic artery at an 
early part of the operation. 
VOL. xv. 3 D 
