Lithotomy.—The extraction of a urinary calculus from the bladder by
the recto-urethral operation has been now successfully accomplished by
Mr. Lloyd, in three instances, at St. Bartholomew’s Hospital. The stone
was removed quickly, and the patients have done well. It may, there-
fore, be interesting to state, that the proceeding resembles, in great mea-
sure, the operation performed by Vacca Berlinghieri, and described by
Malgaigne. (Manuel de Medicine Op£ratoire,p. 686, 1843.) The sub-
ject having been placed as in the lateral operation, a staff is introdued
into the bladder, and given to an assistant, who is directed to hold it
in a vertical direction, so that the groove should correspond exactly
with the mesial line. The index finger of the left hand is introduced
into the rectum, the palmar surface being turned forwards. Upon
its flat surface a straight bistoury is inserted to a depth of eighteen mil-
limetres (about nine lines) from the margin of the anus. The handle of
the knife being then depressed, the point is thrust through the walls of
the intestine, and the edge being also carried upwards, the sphincter
ani, the inferior part of the rectum, the perinaeum from the anus to the
bulb, and the cellular interval which separates these parts, are divided
together. The inferior region of the prostate can then be felt through
the wound. In front is felt the membranous portion of the urethracon-
taining the staff. The nail of the index finger is next used, as in the
lateral operation, to discover the groove in the staff, and to conduct to it
the point of the bistoury. The staff is then withdrawn, and the bistoury
is thrust into the bladder; the edge is turned downwards, so as to di-
vide partially, but not completely, the prostate in the mesial line, care
Ijeing taken to avoid re entering the incision of the rectum. Therefore,
this operation effects the division of those parts which were torn in the
old operation with which the “ apparatus major” was associated. Mr.
Lloyd introduces a speculum into the rectum; his incision is, perhaps,
somewhat deeper than that of Vacca Berlinghieri; he dilates, but does
not cut the prostate, unless the stone should be of very considerable size.
The incision appears remarkaby small when the operation is concluded;
and, as Malgaigne has observed, at each effort of excretion, the mucous
membrane descends over the wound, which is thus placed under condi-
tions most favorable to healing without leaving a fistula.—Med. Times
•and Gaz.