I open the forceps and flide one blade underneath it, and the other at top; and if I apprehend the ftone is not in the right place of the forceps, I shift it before I offer to extract, and then extract it very deliberately, that it may not flip fuddenly out of the forceps, and that the parts of the wound may have time to ftretch, taking great care not to gripe it so hard as to break it, and if I find the stone very large, I again cut upon it as it is held in the forceps. Here I must take notice, it is very convenient to have the bladder empty of urine before the operation, for if there is any quantity to flow out of the bladder at the paffing in of the gorget, the bladder does not contract but collapfe into folds, which makes it difficult to lay hold of the stone without hurting the bladder; but if the bladder is contracted, it is so easy to lay hold of it, that I have never been delayed one moment, unless the stone was very finall. Laftly, I tie the blood-veffels by the help of a crooked needle, and ufe no other dreffing than a little bit of lint befmear'd with blood that it may not stick too long in the wound, and all the dreffings during the cure are very flight, almost fuperficial, and without any bandage to retain them; because that will be wetted with urine, and gall the skin. At first I keep the patient very cool to prevent bleeding, and fometimes apply a rag dipt in cold water, to the wound, and to the genital parts, which I have found very useful in hot Tt 2 weather weather particularly. In children it is often alone fufficient to stop the bleeding, and always helpful in men. The day before the operation I give a purge to empty the guts, and never neglect to give some laxative medicine or clyfter a few days after, if the belly is at all tenfe, or if they have not a natural stool. What moved me to try this way, if I may be allow'd to know my own thoughts, was the confideration of women scarce ever dying of this operation, from which I concluded, that if I could cut into the urethra, beyond the corpora cavernofa urethræ, the operation would be nearly as fafe in men as women. WHAT fuccefs I have had in my private praЄtice I have kept no account of, because I had no intention to publish it, that not being fufficiently witneffed. Publickly in St.Thomas's hofpital I have cut two-hundred and thirteen; of the first fifty, only three died; of the second fifty, three; of the third fifty, eight; and of the last fixty-three, fix. Several of these patients had the fmall pox during their cure, fome of which died, but I think not more in proportion than what usually die of that diftemper; these are not reckon'd among those who died of the operation. The reason why so few died in the two first fifties was, at that time few bad cafes offer'd; in the third, the operation being in high requeft, even the most aged and moft miserable cafes expected to be fav'd by it; befides, at that time, I made the operation very lower lower in hopes of improving it, but found I was mistaken. But what is of moft confequence to be known is the ages of those who recovered, and those who died. Of these, under ten years of age one hundred and five were cut, three died; between ten and twenty, fixty-two cut, four died; twenty and thirty, twelve cut, three died; thirty and forty, ten cut, two died; forty and fifty, ten cut, two died; fifty and fixty, seven cut, four died; fixty and seventy, five cut, one died; between seventy and eighty, two cut, one died. Of those who recovered the three biggeft ftones were 3 xii, x, and viii, and the greatest number of ftones in any one perfon was thirty-three. One of the three that died out of the hundred and five, was very ill with a whooping cough; another bled to death by an artery into the bladder, it being very hot weather at that time: But this accident taught me afterwards whenever a veffel bled that I could not find, to dilate the wound with a knife, till I could fee it. Now if JACQUES or others who of late have been faid to have performed this operation, whether by defign or chance, did not take care to fecure the blood-veffels, which as yet has not been fuppofed, whatever their dexterity in operating might be, their fuccefs at leaft can be no fecret, for many of their children and most of their men patients must have bled to death. If I have any reputation in this way, I have I have earn'd it dearly, for no one ever endured more anxiety and sickness before an operation, yet from the time I began to operate, all uneafinefs ceased; and if I have had better fuccefs than fome others, I do not impute it to more knowledge, but to the happiness of a mind that was never ruffled or difconcerted, and a hand that never trembled during any operation. AN ESSAY Towards a New PHARMACOPOEIA CHIRURGICA. 'HE furgery medicines in the public phar from surgery writers) being for the most part compounded of too many ingredients, fome of which are not to be had genuine; fome spoiling the confiftence of the medicine, and fome of very little efficacy, I have therefore contrived one for my own use, in which I hope these mistakes are avoided, part of which I here offer to the publick; if it is well received I intend hereafter to give the whole, with remarks upon the uses of the particular medicines. Emp. Emp. Adhæfivum. R Emp. Diach. fimp. Ib xii. This plaifter is fufficiently adhesive if the diachylon is made with good oil, as it ought to be, and without any animal fat. Emplaft. e Cortic. Querc. feu Defenfivum. Add. Litharg. Aur. x. Ol. Olivar. Ib xx. Pic. Burgund. iii. M. F. E. S. A. This plaifter is much more ftyptic than the Emplaftrum e bolo, and of a much better confiftence. Emp. e Capfico Indico. Capfic. Indic. b i. Coq. in Aq. lb xvi. Colat. ad 1b xii, Ol. Olivar. b xvi. Pic. Burgund. Ib iii. Cer. Flav. 1b ii. M. F. E. S. A. This plaifter is much warmer than that of Paracelfus or the Diachylum cum Gummi. Ung. Bafil. Nigr. B Ol. Olivar. Ib iii. Cer. flav. fb ii. Pic. Naval. b iv. M. F. Un. S. A. This is a milder digeftive, and lefs apt to raise fungous flesh than the following. Ung. |