Of the LESSER APPARATUS, or Cutting on the GRIPE.
THE most ancient way of cutting for the Stone, is that described by Celsus, and known by the Name of Cutting on the Gripe, though since the Time of Johannes de Romanis, it is also called, Cutting with the lesser Apparatus, to distinguish it from his new Method, which on account of the many Instruments employed in it, is called Cutting with the Greater Apparatus. The Manner of doing the Operation is this: You first introduce the Fore-finger and Middle-finger of the left Hand, dipt in oil, up the Anus, and pressing softly with your right Hand above the Os Pubis, endeavour to bring the Stone towards the Neck of the Bladder; then making an Incision, on the left Side of the Perinæum, above the Anus, directly upon the Stone, you turn it out through the Wound, either with your Fingers or a Scoop.
This Way of Cutting was attended with many Difficulties, for want of proper Instruments to direct the Incision, and extract the Stone, when it lay beyond the Reach of the Fingers, which in a large Bladder was frequently the Case; so that 'tis strange Celsus confined the Operation to the Age between Nine and Fourteen, since it is much easier to be performed in Infancy, than at those Years; and it plainly appears from his Account of it, that many died from the Violence done to the Bladder in endeavouring to bring the Stone forwards, though the Operators failed in their Attempt, and the Patients were not cut.
The Wound of the Bladder in this Operation is made in the same Place as is now practised in the Lateral Method; but it being impracticable on some Subjects, and uncertain on all others, has made it universally exploded; so that no body now makes an Incision without the Direction of a Staff, unless a Stone entirely prevents the Introduction of it, by pressing against, and stopping up the Neck of the Bladder; and in this Case, when we cut directly upon the Stone, it, is much safer to push it back farther into the Bladder, and lay hold of it with the Forceps, than to endeavour with the Scoop or Fingers to force it outwards, which Circumstance alone makes it different from Celsus's Method. It must be distinguished however, when I speak of pushing the Stone back, that I suppose it in the Neck of the Bladder; for it frequently happens that it lies at the Extremity of the Urethra, on the Outside of the Bladder; in which Case the Wound of the Urethra may be made large enough to turn it out with the Fingers, or the End of some slender Instrument.