Of the GREATER APPARATUS, or the Old Way.
THIS Method of Cutting, invented by Johannes de Romanis, and published by his Scholar Marianus in the Year 1524, has at different Times, and with different People, varied considerably in some of its Processes, and particularly with regard to the Use of certain Instruments. What I shall describe, will be the Manner, in which it is now practised with all its Improvements.
Having laid the Patient on a square horizontal Table, three Feet four Inches high, with a Pillow under his Head, let his Legs and Thighs be bent, and his Heels made to approach his Buttocks, by tying his Hands to the Bottom of his Feet, with a Couple of strong Ligatures, about two Yards long; and to secure him more effectually from struggling, pass a double Ligature under one of his Hams, and carry the four Strings round his Neck to the other Hand; then passing the Loop underneath it, make a Knot by threading one of the single Ends thro' the Loop: After this, the Thighs being widened from each other, and firmly supported by proper Persons, you introduce the Staff, having first dipt it in Oil, which must be held by your Assistant, a little leaning on the left Side of the Seam in Perinæo; and beginning the external Wound just below the Scrotum, (which must be held out of the Way) you continue it downwards, to within two Fingers Breadth of the Anus; then leaving that Direction, you slip the Knife forwards in the Groove, pretty far into the bulbous Part of the Urethra; or, as there is some Danger of wounding the Rectum, in the Continuation of the Incision, you may turn the Knife with the Back towards it, and make this Part of the Incision from within outwards. Should a very large Vessel be cut, it will be adviseable to tie it before you proceed any farther in the Operation. When the Wound is made, slide the Gorget along the Groove of the Staff into the Bladder; and to do it with more Safety, when the Beak of it is received in the Groove, 'twill be proper to take the Staff yourself in your left Hand; for if the Assistant should, unwarily, either incline the Handle of it too much towards you, or not resist enough to the Force of the Gotget, it is very apt to slip out of the Groove, between the Rectum and the Bladder, which Accident is not only inconvenient to the Operator for the present, but is attended for the most part with very bad Consequences. The Gorget being passed, dilate the Urethra and Neck of the Bladder with your Fore-finger, and, introduce the Forceps into the Bladder, keeping them shut 'till you touch the Stone, when you must grasp it with a moderate Force, and extract it by pulling downwards towards the Rectum. Should you find a Difficulty in laying hold of the Stone, be careful to keep your Forceps in such a Position, that they may open upwards and downwards, (not laterally) which will very much facilitate the embracing of the Stone, in case it should happen to be thin and flat.