1000000031

m:: ts

with

obfi nlét:O:l 2t

the ncck. raire its extrc–

mity

upw:uds.

inclining

th::

hanote

je towards

you';

ie don'( rheo

n.p

in, withdraw ie a

qUoHler

o( an

I"ch.

anJ

in(ro\lucir.~

yO!.: f

(ore-finger io:.o

(he

rrfiurn ,

lift

up,

onu

will ,rddonl t"il

to enter:

there

is fome aft in

lurning

,he (rJ.und

ID l he

proper pl;;cc of the

t11(//¡ra,

which Cur–

geO:l'l nOl

verfed

in thls oper..tion c::tonal (o weJl e.x.eCute ;

then:fo re (hey may

pars

che

innrument

Wilh lhe

CODC¡VC

filie

always

lowards

che

abJo!ntll

of che

palienr,

obfervillg (he

fame rule

che

en_ C10te

into

lhe

blacirler as in

lhe

tHher

m«hud. The e, ufe of Ihis obllacle, befides Ihe

rug'"

of the

urelhra ,

and tbe refill ...nl.:e

the

t'f'ru lIl?nl olJum,

is fome –

times a (n¡aH projetllon of the ori6ee of lhe

IJl;vldtr, in (he

flrelhra ,

like:

th.u of the

()I linc.r

the:

fJa.~ina,

whieh oc–

cafions lhe

cnei of

the

fou r.d

O'p a

littlc

beyono

il.

T !10Ugh.

upon fea rehing,

wc:

are a(fllrcd of

{tone in the

bbddcr, we are nor, without further inquiry,

op:rate

im–

mediatdy; fioce there Rre Cometimes obllacles whieh for–

bid th\!

opc:ration, eilher abfollltely, or ooly for

ceruin

time; among (hefe, tb.u of greatell confequence, is lbe

gravel or Hone in Ihe kidneys . The objetlions of

I.fs

weight,

~na

which freqllently are removed, are a

lit

of the

llone. a cough , a beétic, and being emaciated by long

p~in;

cxceflive hOl or cold weather are Jikewife hindrances: Bet

iD eraremily of dangor, Ihefe lan confideralÍons may be

d ifregHded.

DdFerence of age make5 an extreme difference of daoger.

iDfan" " nd young people almofl always recoocring; bUlllill

the oper:uion i5 advife:. ble on thofe advaoced in yens, tho'

is nOl 3ttended wi,h near lhe fame fueceCs . This ope–

ration is performed {our feveral w'ys, . 11 wh'eh we (hall

deferibe.

Of tht

Lu,...

A'PAI.ATU.,

or Cut/ing on

th.

G ~I",

THs mofl ancienl wayofeuuing (pr Ihe flone, is Ihat de–

feribed by

Celful,

and k.o",n by Ihe name 01

cu/ling on

th~

gripe;

thoug~,

Goce: (he

time of

J ()hannel de

R OlllltniJ .

it is alfo ca11ed

cutting 'Wilh Ih.

"11"

apparalul ,

lO difiin–

¡:uifh it froro his new method, which . on

Iccount

of (he llJany

in(lrumems

cmploycd

it.

callcd

cUllin~f

1JJ;th ¡he

greal·

aplaralul.

Thc manner of

doing Ihe operation

¡s

Ihis

You 6rfl introduce the (ore finger and middle' 6nger of Ihe

lefl hand, dipt in oil, up Ihe

anUl,

.nd prelling foftly wilh

your right hand aboye lhe

()I

pllbÍJ,

(ndeavour

bring

die

Ilone

towards the ncck of Ihe bfadder; then

mÍl.kíng

in–

cilioo,

the left

fide of

the

peri!/tt tun.

abon°

the

anUI ,

direflly upon the llone,. you

turo

out through che wound

cilher ,,!ith your fingers ur

(coop.

This

way of

cuuing was attended with m,iIOY

difficllhies,

(or

Want

proper in(lruments

diretl

the

¡"cilion. 2nd

~xtratl

Ihe flone, ",hen il lay beyond the

re.éh

of Ihe fi o·

gers, whieh in a large bladder' was frequently Ihe c.,fe .

The wound of the

bladocr in Ihls opel"tion

is m.lde in the

fame place

as i5 now pratll(ed

the laleral method ; bue

being

impralticable

fome fubjeéts . 2nd unccrtain on

al! o–

thero, ha. made il uoiverfa lly exploded.

oí1h.

GREATE~ A'P'~ATU',

or Ihe

Old

,:" y.

mel hod of

cutti ng, inventrd

J ,hanntl

de Ro,,:o–

"i},

h..s

olfrc(l";nt

time5, aod wifh different people,

varl(d

confidn ...

bly

in fome o( its procdfrs. anri p:nticularly with

regard lO Ihe uf< o( certain iDflruments. What we (h,1l

VOL . U!.

N'?6,

deferibe, \ViII be Ihe

m.nn«

in whieh

Íl

i, no", pratlifcd

wilh all its impronments.

Hav, ng hid (he p;uil'nt

0 0;l rC:llafc

horizontal

I~hle.

thrc:e

feet four ¡oches

high,

WHh

r;lIow

undc:r tllS

he;,d,

I~t

hi ..

Jegs and th'chs be bent,

and

111$

hcels

maQe

tOapproach

his

bultocks,

'ying his

h~nds

thc:bouom ofhi", f':ct, w:th

collple

llrong liga:llres, about tWQyards lung;

3nd,o

I~cu re

him

more

etfc:ttually

from

nrug~ling,

par, a

dnuble

I'ga:urc

under cne

of hi,

hams ,

and carry

lhe

four

flr m¡;s

round

his

n~ck

the other

h3m;

,hen

p::!ffiog ,he

IhO ~

on\jc:rnealh

n, makc a knot

by threading

ene of

lhe fin gle

toJo Ihrough Ihe loop : After Ihis, Ihe Ihighs being wid.n–

from e3eh mher.

and

firmly

fllpported

by prooer

rer–

fans. ylJu introduce thelhfF, having

firlt

it in oil. which

mufl b. held by your alliflanl, a liule leaning on Ihe left

fide of (he feam

p~rintr();

and beginning the externa)

wound jufl bclow

,hefcrolum.

(which mul! be hcld 001 C)f

the

\II::I.y.)

you .continue

do\~nwards,

within

(wo fingers

breadrh of the

anuI;

chen leaving Ihat direélion, you

flip

the

kni(e

forwards in the groo. e. pretty far inlo

(he

bul–

bo~s

pan of

the

urethrll;

or, as tbere

Come danger

wounding the

rltlum,

in the continuation o( the ¡nci(jon,

you may

IUro

the knife with (he back towards

il,

2nd m..

this pan of (he ¡ncifioD(rom within oU(Ward5. Should

.ery large vefTcI be cut, it will be adTiCeable

tie

be(ore

you procced any (anher in the operation . When ,he \lIound

is made, fl ide lhe gorgct along ,he g,oove

Ihe

Ihff

ioto

tlÍe bladder; and lO do it wilh mor. [a{«y, when Ihe beak

recelyed in the groove, it will be proper

tak~

the

It.ff

you rfelf iD your

h.nd

: for if the .1Ii1:anl (hould,

unwarily,~

eitber

incline lhe haDdle

il too. much towards

you. or nOI refin enotlgh to the force of the gorgel. it

very apt to

Oip

out of Ihe ¡roove, between

lhe

r~{lu,"

and

the bJaddt r¡ which accident is not ooly iocoovenienl tO

the

operator for the prefenl, but is auended (or I'he moO pal

wilh Yery bad confequences. The gorg« being p,fred, di–

late Ihe

urdhra

and neck of the bladder

with

your

fore.hn–

ger, and introduce the forceps ¡nlb (he bJadoer, keeping

them (hUI tiJl you toueh the !Ione, ",hen you mufl grafp it

wi th

moderate force, and extralt it

pulling doVUl–

ward. towards Ihe

rdlum,

Shollld you r,nd , difficulty in

laying hold of Ihe flone, be eareful lO keep your foreeps in

fueh • pofilion. thal lhey may ope,! upwards and down–

ward." (nol laterally,) whieh willvery mueh faeili",e Ihe

embraeing of the ftone, in eafe i[ (hould happen lO be IhlO

and

Il.t.

Oí

Ih.

HIGH

OP"~T ION.

T H

method of euuing for Ihe 1I0ne was firll publithed

in the year

Pierre Franc().

About the year

17 I

'l.

il w"' fidl done in

Englal1'

by IIfr

D,ughl,

, nd a{–

ter him praétifed

olhen. The mi!.nner of performior.

it .

with the

Imp'

ovc:mcnlS made fince

ronco's

oper:uiCln, is this.:

The patic:nt

being

bid

fquare tabJe, wlth his

Ic~s hafl~ing oyer, and fanencd

the ' des

hg.f.tu

DJlr_

ed above the kncc: his head . nd body hflcd up a liule

t>y

pillow5, fo

to re1.-tJlt the abdominal mllfclt"s .

ano his h

¡nos

held

fieady by

fome affillanu; injc:f\

throu~h

Catheler

lO–

tO the bladdcr

as much

barley.w~ter

he can

h~.1 r.

"'hich

in aman is often about eight ounees, and (ometlmts.

twelTe. For th e mOre eafily doing this. an ox's

tlr~/er

may

be tied

the extremilY 01 [he fyringe, aod handle

Ihe

c.thc«r,