Of the HIGH OPERATION.
THIS Method of Cutting for the Stone was first published in the Year 1561, by Pierre Franco, who in his Treatise of Hernias says he once performed it on a Child with very good Success, but discourages the farther Practice of it. After him, Rossetus recommended it with great Zeal, in his Book intitled Partus Cæsareus, printed in 1591; but he never performed the Operation himself. Monsieur Tolet makes mention of its having been tried in the Hotel Dieu; but without entering into the particular Causes of its Discontinuance, says only that it was found inconvenient. About the Year 1719, it was first done in England by Mr. Douglas, and after him practised by others. The Manner of performing it, with the Improvements made since Franco's Operation, is this:
The Patient being laid on a square Table, with his Legs hanging off, and fastened to the Sides of it by a Ligature passed above the Knee, his Head and Body lifted up a little by Pillows, so as to relax the abdominal Muscles, and his Hands held steady by some Assistants; inject through a Catheter into the Bladder as much Barley-water as he can bear, which in a Man, is often about eight Ounces, and sometimes, twelve: For the more easily doing this, an Ox's Ureter may be tied to the Extremity of the Syringe, and Handle of the Catheter, which being pliable, will prevent any painful Motion of the Instrument in the Bladder.
The Bladder being filled, an Assistant, in order to prevent the Reflux of the Water, must grasp the Penis the Moment the Catheter is withdrawn, holding it on one Side, in such a manner, as not to stretch the Skin of the Abdomen; then with a round-edged Knife make an Incision about four Inches long, between the Recti and Pyramidal Muscles, through the Membrana Adiposa, as deep as the Bladder, bringing its Extremity almost down to the Penis; after this, taking a crooked Knife, continue the Incision into the Bladder, carrying it a little under the Os Pubis, and immediately upon the Water's flowing out, introduce the Fore-finger of your left Hand, which will direct the Forceps to the Stone.
This Method was at first received with great Applause in London, but after some Trial was rejected, for the following Inconveniencies: It sometimes happens that the Bladder, notwithstanding the Injection, still continues so deep under the Os Pubis, that the Peritonæum being necessarily wounded first, the Intestines push out immediately at the Orifice, and the Urine afterwards empties into the Abdomen; in which Case, hardly any recover. The Injection itself is exceedingly painful, and however slowly the Fluid be injected, it distends the Bladder so much more suddenly than the Urine from the Kidneys does, and so much faster than it can well bear, that it not only is seldom dilated enough to make the Operation absolutely secure, but is sometimes even burst, or at least its Tone destroyed by the hasty Dilatations. What adds to the Danger here, is the Possibility of meeting with a contracted indurated Bladder, which is a Circumstance sometimes attending on the Stone, and indeed an exceedingly dangerous one in all the other Methods, but would be frightful in this, by reason not only of the necessity of wounding the Peritonæum, but of the Difficulty of coming at the Stone. If the Stone be very small, it is hard to lay hold of it with the Forceps, and in a fat Man, the Fingers are not long enough for that Purpose. If there are many little Stones, it will scarce happen that more than one at a time can be extracted; and if the Stone breaks, it not only is impracticable to take it all away in the Operation, but also from the supine Posture of the Patient, it will generally remain in the Bladder; whereas in the other Methods, for the most part, it works itself out with the Urine. But even supposing that the Operation itself is prosperous, the Consequences generally are very troublesome; for the Urine issuing out at an Orifice where there is no Descent, spreads itself upon the Abdomen, and makes very painful Excoriations; though, what is still worse, it sometimes insinuates itself into the Cells between the Bladder and Abdominal Muscles, and together with the Inflammation excited by the Operation, brings on a Suppuration there, which is always difficult to manage, and frequently mortal.