the
seminal vessels converging to the prostate from either side, and the
recto-vesical serous pouch behind, will escape being wounded. If the
prostate happen to be much enlarged, the relative position of the
neighbouring parts will be found disturbed, and in such case the bladder
can be punctured above the pubes with greater ease and safety. In cases
of impassable stricture, when extravasation of urine is threatened, or
has already occurred, the urethra should be opened in the perinaeum
behind the place where the stricture is situated, and this (in the
present instance) certainly seems to be the more effectual measure, for
at the same time that the stricture is divided, the contents of the
bladder may be evacuated through the perinaeum. If the membranous part
of the urethra be that where the stricture exists, a staff with a
central groove is to be passed as far as the strictured part, and having
ascertained the position of the instrument by the finger in the bowel,
the perinaeum should be incised, at the middle line, between the bulb of
the urethra and the anus. The urethra in this situation will be found to
curve backwards at the depth of an inch or more from the surface. The
point of the staff is now to be felt for, and the urethra is to be
incised upon it. The bistoury is next to be carried backwards through
the stricture till it enters that part of the urethra (usually dilated
in such cases) which intervenes between the seat of obstruction and the
neck of the bladder.

The lateral operation of lithotomy is to be performed according to the
above described anatomical relations of the parts concerned. The bowel
being empty and the bladder moderately full, a staff with a groove in
its left side is to be passed by the urethra into the bladder. The
position and size of the prostate is next to be ascertained by the left
fore-finger in the rectum. Having now explored the surface of the
perinaeum in order to determine the situation of the left tuberosity and
ischio-pubic ramus, in relation to the perinaeal middle line, the staff
being held steadily against the symphysis pubis, the operator proceeds
to divide the skin and superficial fascia on the left side of the
perinaeum, commencing the incision on the left of the raphe about an
inch in front of the anus, and carrying it downwards and outwards midway
between the anus and ischiatic tuberosity, to a point below these parts.
The left fore-finger is then to be passed along the