104 TRANSLATIONS FROM THE CONTINENTAL JOURNALS. 
membrane not being injured thereby, but it must be done 
skilfully. A leaden probe is the best instrument for this 
purpose, which should be blunt pointed. In default of this, 
a whalebone one may be used advantageously. This mode 
of proceeding might be deemed irrational, but it must be 
borne in mind that calculi are often numerous, and that 
by returning one into the bladder little harm can be done. 
Directl} 7 the stone is removed, the urine begins to flow freely, 
unless the coats of the bladder have lost their power of con¬ 
traction by over- distension, in which, case the hand must be 
introduced into the rectum, when by means of a moderate de¬ 
gree of pressure, the contents will be expelled; after which, 
the coats gradually recover their tone, but this sometimes 
does not take place under two or three days. 
The non voiding of the urine after the operation sometimes 
depends upon spasm of the neck of the bladder. This is 
easily ascertained by the operator not being able to empty the 
bladder by the above-named pressure. 
Other calculi might also be retained in the course of the 
urethra. It is very important to ascertain this; which may 
be done by injecting it with water, by means of a small 
syringe. If this be the case, it is important to remove them 
in order to allow of the urine passing off by its natural 
channel. This may be done by endeavouring to push the 
calculi either towards the ischial region or the end of the 
penis. In the impossibility of effecting this, the operation 
of cutting down upon the largest stone must be resorted to. 
In doubtful cases of the location of the calculus the question 
is—Should the incision be made where the obstruction is 
in nineteen cases out of twenty, namely, in the ischial 
region ? Bernard was, for reasons he has stated, in the 
Journal du Midi , 1840, in favour of the ischial region. If 
urethrotomy is performed in the scrotal region, the incision 
in the skin should be made large, and the surrounding cellu¬ 
lar tissue freely dissected to guard against the infiltration 
of urine consequent on the operation. The incision is also 
to be made longitudinally with the urethra, with a view of 
preventing too speedy an adhesion, and it should likewise 
be sufficiently long. 
