Lithotomia Douglassiana: or, an account of a new method of making the high operation, in order to extract the stone out of the bladder. ... Invented and successfully perform'd by John Douglas, surgeon.

Lithotomia Douglaſſiana: OR, An Account of a NEW METHOD of making the HIGH OPERATION, in order to extract the Stone out of the Bladder, &c.

IN this new Operation, I cut on the lower Part of the Belly. In the common Operations, viz. Cutting on the Staffe, and cutting on the Gripe, they cut on the Perinaeum, i. e. between the Teſticles and Fundament.

This Section is call'd by Authors, The High Operation, or Hypogaſtrick Se • tion.

I have hitherto only • et with three, that ever pretended to have made it: The firſt of whom is Peter de Franco of Turriers in France, of which he gives the following Account in his Treatiſe of Hernio's, (at the End of the 33d Chapter, Page 139) publiſh'd at Lyons in the Year 1561, in theſe Words: "Hiſtoire, Je reciteray ce que une fois m'eſt advenu voulant tirer une pierre a un enfant de deux ans ou environ: auquel ayant trouué la pierre de la Groſſeur d'um aeuf de poulle, ou peu pres, je fey tout ce que je peu pour la mener bas: & voyant que je ne pounoye rien avancer partous mes efforts, avec ce, que le patient eſtoit merueillcuſement tormenté, & auſſi les Parens deſirans qu'il mouruſt pluſtoſt que de viure entel travail: Joint auſſi, que je ne vouloye pas quil me fut Reproché de ne l'avoir ſeu tirer, (qui eſtoit à moy grand folie) je deliberay avec l'importunité du pere, Mere, & amis, de Copper le dit enfant par deſſus l'os Pubis, d'autant que la Pierre ne voulut deſcendre bas, & fut Coppé ſur le Penil, un peu a Coſtè & ſur la Pierre. Car je leuoys icelle avec mes doigts, qui eſtoyèt au fondment, & d'autre Coſté en la tenant ſubiette avec les mains d'un Serviteur qui comprimoit le petit ventre au deſſus de la pierre, Dont elle f • t tirée hors par ce moyen, & puis apres le patient fut guary, (non obſtant qu'il en fut bien malade) & la playe conſolidée: Combien que je ne conſeille a • omine d'ainſi faire. Ains pluſtoſt uſer du moyen par nous ino • nt • du quel nous venons de parler."

This is (in his own Words) all that he ſays about it: Which, for the Benefit of thoſe that don't underſtand French, I ſhall tranſlate into Engliſh, thus:

"He ſays, he had a Child about two Years old, who had a Stone in the Bladder as big as a Hen's Egg, brought to him to cut: He uſed all his Dexterity to force the Stone down to the Neck of the Bladder, but found it impoſſible to be done: The Child was in that Torture and Miſery, that the Parents wiſhed him rather dead, than he ſhould live longer in ſo doleful a Condition. De Franco, on the other Hand, thinking it would tend to his Diſhonour not to take away the Stone, at laſt reſolv'd to make Tryal, whether he could not bring it to the very Groin, which he did, by putting his Fingers into the Fundament, and raiſing up the Stone, he caus'd his Servant, on the other Side oppoſite to him, to preſs it down to the Place intended for Inciſion; which he made, took out the Stone, and, tho' the Child was very weak, recover'd him, and heal'd the Wound: But he adviſes others not to follow his Example; and, inſtead of it, recommends the Operation which he calls his own Invention, and has deſcrib'd, in the foregoing Part of the ſame Chapter."

The next to him, that's ſaid to have perform'd it, is one Bonnet, of whom Monſ. Tollet, in the 5th Edition of his Lithotomy, publiſh'd at Paris 1708, gives the following Account, Page 139.

"Feu M. Jonnot m'a dit autrefois que M. Bonnet Chirurgien, qui praetiquoit il ya tres-long-temps la Lithotomie dans l' Hôtel Dieu de Paris, l'avoit aſſuré d'en avoir taillé de cette faaeon. M. Petit, Maitre Chirurgien faaeon de cet Hoſpital mà dit l'avoir vu pratique ſur une Petite fille par le même M. Bonnet."

"Mr. Tollet ſays, that the late Mr. Jonnot (who was alſo a famous Lithotomiſt) told him formerly, that Mr. Bonnet, a Surgeon, who practis'd Lithotomy a conſiderable Time ago in the Hotel Dieu at Paris, aſſur'd him, (viz. Mr. Jonnot) that he had cut after that Manner. Mr. Petit, Maſter-Surgeon of that Hoſpital, alſo told our Author, that he had ſeen it practiſed by the ſame Bonnet on a young Girl."

Monſ. Dionis, in the 2d Edition of his Courſe of Chirurgical Operations, publiſh'd at Paris 1714, Page 139, gives the following Account of the ſame Man, viz.

"On nous aſſure que Monſieur Bonnet a pratiqué ſovent cette Operation à l'Hôtel Dieu de Paris avec une heureux ſuccés, & que même Monſieur Petit luy a vû faire."

"We are aſſur'd, that Monſ. Bonnet, frequently and with good Succeſs, perform'd this Operation at the Hotel Dieu in Paris; and that Monſ. Petit has ſeen him perform it." This is all the Account that I have met with of this Bonnet.

After him, Dr. Groenevelt was the next that perform'd it, of which he gives the following Account in the Engliſh Edition of his Lithotomy, publiſh'd at London in 1710.

"I once had a Patient in Long Lane, Moorfields, upon whom I was oblig'd to perform this High Operation; and very ſucceſsfully extracted the Stone, by making Inciſion near the Groin, the Patient ſoon recovering; which ſhews, that Wounds in the fibrous Part of the Bladder are not always mortal."

Thoſe are the only Three that I have met with, that ever pretended to have cut above the Os Pubis, i. e. into the Belly.

Franco cut ſo firſt, becauſe he had a Patient that he could not cut his own Way, tho', at the ſame Time, he had the Character of one of the beſt Lithotomiſts of his Age. But tho' he ſucceeded, yet, it ſeems, he found ſuch Difficulties in it, that he would never do't again, and charges us never to follow his Example; which one would have expected that he ſhould have explain'd in his Account of it, the better to deter others from the like Practice.

Bonnet is ſaid to have done it ſeveral Times with Succeſs; yet he don't recommend it to others as a Rule of Practice, nor was ever imitated by any of his Contemporaries.

Groenevelt did it but once, and ſays, he was oblig'd to do it: I ſuppoſe, in ſome ſuchlike Caſe as De Franco's; and though he alſo ſucceeded, yet, inſtead of recommending it, he only draws this Conſequence from it, viz. That Wounds of the fibrous Part of the Bladder are not always mortal.

Franco cut on the Hair above the Pubis, a little on one Side; Groenevelt near the Groin: But not one of them tells us what luſtruments they uſed, or which Way they uſed them; whether they made a croſs, oblique, or longitudinal Inciſion; whether they made the Inciſion at once, or at ſeveral Times, or what Poſition they put their Patient in; all which, and many more Circumſtances, ought to have been exactly deſcrib'd, before any one could be ſaid to have follow'd their Method; from whence I may very ſafely infer, that it will be no eaſy matter to tell which Way any of them made their Operations, and yet it's commonly aſſerted with the greateſt Aſſurance (not with any Deſign to raiſe De Franco's Reputation, but to leſſen mine) that I made this Operation after De Franco's Method, though he has told but very little of his Story, and I have told none of mine.

Upon the Whole, I muſt ſay, that it's a Miracle to me, that after ſo much Succeſs, either they, or thoſe that ſaw them do it, did not either continue the Practice of it, or give us more ſubſtantial Reaſons why they diſapprov'd of it; ſo far from that, they have not given us one Inſtance of a Patient's dying after this Section.

This Operation is alſo recommended as a very probable Way by Rouſſecus, Dionis, &c. yet not one of them was ever ſo far perſwaded of it as to make the Experiment, however ſeveral of them have undertaken (which none that ever made the Operation thought fit to do) to deſcribe the Method how it may be done, i. e. to teach others to perform what they can't do themſelves; (which, in my Opinion is the greateſt Abſurdity in Nature;) but to what Purpoſe, he that makes the Experiment will ſee.

Having thus recited all the Inſtances that I have met with of the Stone in the Bladder, being extracted through the Belly, in the Words of the Authors, That every one may be a Judge of the Encouragement I had to undertake this Operation from what has been done this Way before.

I ſhall next give an Account of the Objections made againſt the fore-mention'd Gentlemens Operations, by ſome of the moſt authentick Authors that have mention'd them.

Firſt, Some ſay that the Urine from the Bladder, and the Diſcharge from the Wound, will flow into the Cavity of the Abdomen or Pelvis, where Corrupting, will occaſion ſeveral grievous and incurable Symptoms, amongſt whom is Dr. Drelincount, &c. who expreſſes himſelf thus:

"Operatio Franconiana ut inventa eſt ſic exolevit, quia dum perfunderetur Veſicae fundum Urina Effluebat in Abdominis Cavum & Mortem inducit, i. e."

"The Franconian Section, viz. the high Operation, died aſſoon as it was invented; becauſe when the Fund of the Bladder is perforated, the Urine flows into the Cavity of the Belly and cauſes Death."

Secondly, Others ſay that the Wound being made in the membranous Part of the Bladder, won't heal again, amongſt whom is Barbett, &c. who has theſe Words:

"Periculoſa interim & in ſe moleſta Operatio eſt, & quod ſi Labia Vulneris in Veſia facti haud uniantur Muſculis Abdominis, exulceratio veſicae ſequitur, magis dolorifica minus curabilis ipſo Calculo, quae etiam incommoda effecerunt quod minus Operationibus aliis haberi coeperit à practicis veris, i. e."

"It's a dangerous and in it ſelf a troubleſome Operation; and if the Lips of the Wound made in the Bladder don't unite to the Muſcles of the Abdomen, an Ulceration of the Bladder will follow, more painful and leſs curable than the Stone it ſelf, which Inconveniencies have made it leſs eſteem'd than the other Operations by true Practitioners."

Thirdly, Monſ. Thevinin, a very eminent Surgeon, in his Book of Chirurgical Obſervations, publiſh'd at Paris in the Year 1669, Pag. 68. gives this Account of it, viz.

"L'hault appareil qui a eſte premierement pratiqué par de Franco n'eſt point en uſage à preſent, à Cauſe de l'inciſion qui'l oblige de faire au fonds & corps inferieur de la veſſic qui apporte de grand accidens, i. e."

"The high Operation, firſt practisd by de Franco, is no more in Uſe, becauſe the Inciſion being made in the Fund and Body of the Bladder cauſes great Accidents."

Fourthly, Others ſay that the Guts will burſt out at the Wound, &c.

Thomas Fienus, in the 70th Page of his Book, De praecipuis Artis Chirurgicae controverſis, Edit. 1602. gives his Opinion of this high Operation, in theſe Words:

"Praeter hactenus uſitatam Sectionem exorcus eſt, Franciſus Rouſettus, qui in Libro ſuo de Partu Caeſario ſcribit, videri longe ſecuriorem & faciliorem ſectionis rationem futuram, ſi Venter aut Abdomen a Latere ſub umbilico aperiantur, & impoſita per foramen manu veſicae corpus vulneretur & inde calculus eximatur. Sed illa ratio non valet: veſicae enim vulnus lethale eſt, & non poteſt conſolidari, & quamvis aliquando legatur conſolidatum, eſt tamen rara avis, & temerarium nimis foret, & quia illam rationem nemo ſecutus eſt, de ea non agimus, i. e."

"Beſides the common Ways of Cutting, there's one Fr. Rouſettus, who affirms in his Book of the Caeſarian Birth, that the Operation would be ſafer and eaſier, if we cut through the Belly (a little below the Navel, and on one Side) and into the Bladder, and then extracted the Stone through the Wound. But that can't be, becauſe Wounds of the Bladder are mortal, and cannot be conſolidated; altho' we have ſome Hiſtories of their being cur'd, it's a great Rarity, and therefore it's too raſh an Undertaking; and becauſe no Body practiſes it, I'll ſay no more on't."

The Anſwer to all which (not to deſcend to Particulars) is the happy Succeſs of my Operation.

The next Queſtion that naturally follows, is, What could incite or encourage me to undertake this high Operation, which thoſe that had done it, had ſuch an indifferent Opinion of, which thoſe eminent Authors (juſt quoted, and almoſt every one elſe that have mention'd it) exclaim'd ſo warmly againſt, and which, by the common Conſent of Mankind, was deem'd impracticable?

To which I anſwer: That it was, firſt, becauſe I was fully perſwaded that the great Danger, Tediouſneſs, and frequent bad Conſequences of the common Operations, were entirely owing to the Structure of the Parts concern'd, which the beſt Operator could not avoid, if the Stone was of any conſiderable Bigneſs, or of a rugged irregular Figure.

Secondly, Becauſe I was as firmly perſwaded, that all the Objections made againſt the fore mention'd Gentlemens Operations, (ſo far as they concern mine) were very ill grounded; which is prov'd by the Succeſs.

The Two Operations that are only in Uſe now amongſt us are, Firſt, That which Surgeons call Cutting on the Staffe, i. e. When a furrow'd Probe is paſs'd into the Bladder, upon which they afterwards Cut.

The other is call'd cutting on the Gripe, i. e. When they paſs their Fingers into the Fundament, and preſs the Stone outwards, and then cut upon it.

In order to explain what I have juſt now aſſerted, viz. That the Danger, Tediouſneſs, &c. of the common Operations, are entirely owing to the Structure of the Parts concern'd. I ſhall firſt deſcribe the Parts concern'd in each, and then make ſuch Concluſions as naturally follow therefrom.

Cutting on the Staffe is moſt in Uſe, and therefore I ſhall begin with it.

Parts concern'd in Cutting on the Staffe, or Great Apparatus.

Parts Cut:

They cut firſt through the Skin, on one ſide of the Rapha of the Perinaeum.

2dly, Through the Accelerator Muſcle.

3dly, Through the Bulb of the Urethra.

Parts that are dilated.

The Inciſion being made, opens a Paſſage into the membranous Part of the Uretha, at the upper-end of which is the Sphincter of the Bladder, through both which the Inſtruments muſt paſs into the Bladder, and the Stone, tho' enlarg'd by the Thickneſs of the Forceps, muſt paſs out.

They are both apt to be too much dilated by a large, and lacerated by a rugged Stone.

The membranous Urethra, is about Two Inches long, more or leſs, according to the Bigneſs of the Perſon.

It's about as big (in a middle-ſiz'd Man) as to admit of a Gooſe Quill.

It's much longer, and not ſo thick and ſtrong, as the Urethra in Women, and conſequently more liable to be injur'd.

The Sphincter is a few circular Fibres; which keep the Bladder ſhut, and ſo prevents the involuntary Diſcharge of the Urine.

The Genital Parts, which by the Nearneſs of their Situation are liable to be injur'd, next after the foremention'd, are:

Firſt, The Veſiculae Seminales, i. e. the Reſervatories of the Seed: They are ſituate immediately behind the Sphincter, between the Bladder and Rectum, i. e. the ſtraight Gut.

Secondly, Their Ducts; which paſs from them, and open about the Middle of the membranous Part of the Urethra, by Two Orifices, which are cover'd by a ſort of a Caruncle, call'd, Caput Gallinaginis, or Verumontanum; which ſerves inſtead of Valves, to hinder the involuntary emiſſion of the Seed.

Thirdly, The Proſtatae; which are ſituate a Little below the Veſiculae Seminoles, between the membranous Urethra and ſtraight Gut.

The Structure and Situation of the Parts being thus ſtated, it will not be difficult to deduce all die foremention'd Inconveniencies from them, viz.

Firſt, The Danger of this Operation (to ſay no more) will appear from a Computation of the Number of thoſe that do and do not eſcape after it; which is (in general) occaſion'd by the Length and Streightneſs of the Paſſage before deſcrib'd, Figure and Bigneſs of the Stones, Force requir'd to extract them, &c. Whence the foremention'd Parts, &c. are lacerated and contuſed to too great a Degree, and thence exceſſive Pain, Hemorrhagy, Loſs of Strength, &c. too great to be maſter'd.

Secondly, Every one that has made, or ſeen any Number of theſe Operations perform'd, cannot but be ſenſible of the Tediouſneſs of them (and conſequently of the Pain the Patient muſt needs ſuffer) which is owing to the Length and Streightneſs of the Paſſage (which cannot be alter'd, as is commonly ſuppos'd, by enlarging the External Orifice,) Number, and Neceſſary Largeneſs of the Inſtruments uſed; Number, Bigneſs, and Figure of the Stones, &c.

Thirdly, The bad Conſequences that frequently follow this Operation (in thoſe that eſcape with Life) are, Incontinency of Urine, Impotency, Fiſtula's, &c. which every one muſt be ſatisfy'd of, that have ſeen any Number of them: In ſome of whom you'll obſerve • n Incontinency of Urine, in others Impotency, in others Fiſtula's, in others all of them; any one of which is very little better than the Stone itſelf.

Cauſe of the Incontinency of Urine.

It's cauſed when the Sphincter of the Bladder is over-ſtretched by the Bigneſs, or lacerated by the Aſperitys of the Stone; becauſe it can never afterwards do its Office as before; And ſo the Urine flows involuntarily Day and Night; which keeps them always wet, from whence none of the moſt agreeable Scents ariſe.

Cauſe of the Impotency.

It's occaſion'd by the Laceration of the Ducts of the Veſiculae Seminales, or the Verumontanum; and that by the Bigneſs or Aſperitys of the Stone, as before: So when the Wound heals, the Ducts, or Verumontanum; are ſtopp'd by the Callous, ſo that the Seed can no more flow into the Urethra.

Cauſe of Fiſtula's.

Theſe Parts are Membranous, Nervous, or Spermatick, as Authors call them, and, of Courſe, very unapt to heal when wounded, lacerated, or contuſed; which is alſo increas'd by the conſtant Paſſage of the Urine, Gravel, &c. thro' the Wound, and ſo they turn fiſtulous; and then all or a great Part of the Urine, which ſhould paſs thro' the Yard, paſſes thro' the Fiſtula left in the Wound; whence People are made nauſeous to themſelves and others.

The Great Hildanus, pag. 733, expreſſes the Danger of this Operation in theſe Words:

"Ingens ac magnus Calculus ut per Collum Veſicae extrabatur, propter ejus anguſtiam longum requirit tempus, interim aeger ingentibus affligitur Doloribus, Veſica, ipſiuſque Fibrae dilacerantur, Sanguis copioſè profluit, vires diſſolvuntur, maximoque cum Cruciatu aeger vel in ipſa Operatione aut paulò poſt extinguitur, i. e."

"When a large Stone is extracted through the Neck of the Bladder, becauſe of its Streightneſs, it takes up a long Time: In the mean Time, the Patient ſuffers intolerable Pain, the Bladder and its Fibres are tore, there's a great Flux of Blood, Loſs of Strength, and the Patient, by reaſon of the great Torture, dies, either in or ſoon after the Operation."

The late Mr. Couper, in his Comment upon Bidloo, has the following Obſervations on the Accidents which happen from the Structure of the Parts.

"This Part of the Urethra, viz. that between the Proſtatae and the Bulb, is liable to be wounded, and ſometimes perforated, by too haſtily introducing the Conductor into the Bladder, after an Inciſion is made in the Perinaeum in Cutting for the Stone; whereby the Operator afterwards thruſts his Forceps between the Bladder and Rectum."

"This Inadvertency, I'm perſuaded, is very often practiſed by the Pretenders to Lithotomy, and frequently proves fatal to the Patient: One would think it hardly poſſible, that a Man in his Senſes, and but tolerably acquainted with Anatomy, could commit ſuch Errors; yet, of this I have met with more than one Inſtance, when being called to diſſect the Deceaſed, in whom ſuch Operators have been ſo unfortunate as to leave the Stone ſtill in the Bladder."

So much to ſhew the unavoidable Danger, &c. of Cutting on the Staffe.

The other Operation in uſe is Cutting on the Gripe.

Parts cut.

They cut (farther off of the Rapha of the Perinaeum than in the foregoing Operation) 1. Through the Skin: 2. The Fat: 3. Part of the Erector Penis: 4. Some confiderable Blood-Veſſels: 5. A Part of the Levator Ani: 6. Into the Body of the Bladder above the Sphincter.

This Operation can't always be practis'd, becauſe our Fingers are not long enough to bring down and keep the Stone faſt againſt the Perinaeum in grown People. Though, when it can be done,

The Inconveniencies of it are,

1. When the Stone is rough, it's troubleſome, painful, and tedious, to make the Inciſion on it. 2. The Arteries, which are cut, are often very large. 3. When the Stone is rough, it pricks, and contuſes the Bladder in ſeveral Places, by being preſſed hard againſt the Perinaeum; whence ſeveral dangerous and deadly Symptoms enſue. 4. The Wound in the Bladder being depending, is hinder'd from aglutinating, by the Gravel and Urine paſſing thro' it, &c.

From all which, I think 'tis evident, that the rare Succeſs of theſe Operations, even in the beſt of Hands, (not to mention the Havock that is often made by Pretenders) is entirely owing to the Structure of the Parts concern'd; which is what I undertook to prove.

Advantages of this new Operation.

Whereas, in the other Operations, the Danger, &c. are owing to the Structure of the Parts; in my Operation, by reaſon of the Structure of the Parts, they are ſucceſsfully prevented. E. G.

1. There can be no Impotency cauſed by it, becauſe there's none of the Genital Parts can be injur'd in doing it.

2. There can be no Incontinency of Urine caus'd by it, becauſe the Sphincter of the Bladder cannot be hurt in making it.

3. There can be no Fiſtula after it, if proper Care is taken of the Wound.

4. There can be no ſuch Force requir'd to extract the Stone, as will contuſe and lacerate the Parts, which, in the other Operations, are the Cauſe of Symptoms too hard to be govern'd) becauſe the Wound may be made as large as you pleaſe, which can't be done in them.

5. There can't be any Flux of Blood, becauſe there's no Occaſion to cut any of the great Veſſels, &c. Thus the Defects of the others are ſupply'd by this.

My Patient was between ſixteen and ſeventeen Years of Age, and was cut two Days before laſt Chriſtmas, and in a Month's Time the Wound was perfectly cicatriz'd, i.e. healed.

The Operation was over in one Minute, and I believe will never be above two.

He now performs all his natural Faculties as well as he had never been troubled with the Stone.

There were two Phyſicians, two Surgeons, and an Apothecary, preſent at the Operation: But to ſave them the Trouble of anſwering every little Prig's impertinent Queſtions, I don't think it's proper to mention them.

The Stone was of the Bigneſs and Figure expreſs'd in the Plate following.

a bladder stone The Natural Figure & Bigneſs of ye stone

Some ſay that I have robb'd the Dead of their Right, and endeavour'd to impoſe on the Living, by putting my own Name to another Man's Work, and pretending that it's a new Operation, though, at the ſame Time, it was practis'd by its firſt Inventor, De Franco, above 150 Years ago.

De Franco (whoſe Memory I reverence, becauſe he was certainly an excellent Surgeon, and one of the beſt Lithotomiſts in his Time) is ſo far from valuing himſelf upon the High Operation, which he was once forc'd to make, that he owns himſelf to be very much to blame for doing of it; and deſires no Man afterwards to follow his Example; and in the Room of that, in the preceding Part of that very ſame Chapter, recommends another which is made on the Perinaeum, which he aſſumes, and, with a great deal of Pleaſure, calls his own Invention.

Hildanus is alſo of the ſame Opinion, and expreſſes himſelf thus, Pag. 730.

"De quarto operandi modo, in Lithotomia uſitato, qui merito Lithotomia Franconiana appellari poteſt."

And ſo he goes on to deſcribe and recommend that Operation, which De Franco owns in the 33d Chapter of his Book, to be his proper Invention: But it's not the High, but an Operation in the Perinaeum, that's aſſum'd by the one, and commended by the other.

In Page 732, he has theſe Words:

"Franciſcus Rouſettus Lib. de partu Caeſario concludere voluit, ſemper calculum eo in Loco exſecandum eſſe, illudque minori cum periculo fieri poſſe. Lithotomiam proinde illam Franconianam vocat, cum tamen D. Franc. eam minimè ad Imitationem praeſcripſerit, ſed expreſſè in Libro ſuo, ſe ſtolide egiſſe fateatur, adeoque unumquemque, ne ipſum hac in parte imitetur, ſed precedentem operandi modum amplectatur, Hortetur."

"Franciſcus Rouſettus, in his Book on the Caeſarian Birth, aſſerts, that we ought always to cut for the Stone through the lower Part of the Belly, becauſe it can be done with a great deal leſs Danger; and then calls it De Franco's Method, notwithſtanding De Franco never preſcrib'd it as a Rule; ſo far from which, he confeſſes in his own Book, that he acted fooliſhly in doing it; and therefore adviſes us never to imitate him in it, but in the Operation juſt before deſcrib'd."

He concludes his Story thus:

"Cum dicto igitur D. Franco, fideli atque induſtrio cuivis Chirurgo periculoſae hujus Lithotomiae Adminiſtrationem iterum atque iterum diſſuadeo."

"Therefore, with the foremention'd De Franco, I again and again diſſuade every faithful and induſtrious Surgeon from performing this dangerous Operation."

From all which I conclude, that inſtead of being an Honour to De Franco, to have had his Name put to it, it would have been a real Injury to the Memory of the Dead, to have made him the Author of an Operation, that he blam'd himſelf for doing when alive.

Nay, I'm ſo far from having an Opinion of De Franco's Operation, as he has deſcrib'd it, that I think it's fully as inconſiſtent and impracticable as Talicotius's Project of reſtoring loſt Noſes.

All the Analogy between his and mine, is, that they are both made in the Belly. But his was made in one Place of the Belly, and mine in another: His, with his own Inſtruments, (which he has not mention'd) mine with mine: His were uſed after one Manner, mine after another: And thoſe, I think, are the moſt material Differences betwixt any two Operations, viz. The Variation of the Place upon which the Operation is made, of the Number, Figure, and Size of the Inſtruments, and of the Method of uſing them.

The two foremention'd Operations, call'd, Cutting on the Staffe, and Cutting on the Gripe, are both made on the Perinaeum: The Deſign of both is the ſame, viz. To extract the Stone out of the Bladder; yet no Man ever was ſo abſurd as to call them both the ſame Operations, for the Reaſons beforemention'd.

The late famous Mr. Rau, Profeſſor of Phyſick and Surgery at Leyden, and the foremention'd De Franco, and ſeveral others, as Celſus, Guido, Marianus, &c. had each a particular Method of Cutting on the Perinaeum, to which every one gave his own Name, and why ſhould not I be allow'd the ſame Liberty.

But ſuppoſing that my Operation was, in every Tittle, the ſame as De Franco's; yet, if it's found to be a ſafer and eaſier Way of relieving the Miſerable, it's nevertheleſs new; for that Operation was as much dead, before mine, and thought as much impracticable, (which the general Opinion of the Town on this Occaſion abundantly proves) as it was 150 Years before De Franco was born.

I readily grant, that one Operation, tho' ſucceſsfully perform'd, is not enough to ſatisfy the Publick that it's the ſafeſt Method; but it's enough to me, who, before the Operation, thought myſelf very ſure of Succeſs, elſe I had never attempted it. But now I have perform'd it, and ſeen the whole Proceſs of the Cure, I'm in no manner of Pain about the future Succeſs of if; nay, I dare venture to prophecy, that not one in ten will die, nor one in fifty want a perfect Cure, that do after the common Methods; and there fore do (what never any did before) recommend it as the moſt eaſy ſafe, and ſpeedy Method of extracting the Stone, (excluſive of all others) in Males, and when the Stone is large, in Females.

I have had a great many vile, malicious and ſalfe Reflections caſt upon me, on this Occaſion, by a Set of Scioli, who (becauſe they never did anything out of the common Road themſelves) envy every Man elſe that does.

The Imputation of Novelty (ſays the great Mr. Lock) is a terrible Charge among thoſe who judge of Mens Heads, as they do of their Perukes, by the Faſhion, and can allow none to be right but the receiv'd Doctrines. Truth ſcarce ever carry'd it by Vote any where at its firſt Appearance: New Opinions are always ſuſpected, and uſually oppos'd, without any other Reaſon, but becauſe they are not already common: But Truth, like Gold, is not the leſs ſo, for being newly brought out of the Mine.

Magna eſt Veritas, & prevalebit.

FINIS.