made would depend in relation to the neck of the bladder; the important
parts, vessels, &c., in the anterior perinaeal space would be avoided
where the incision, if extended upwards, would have no effect whatever
in facilitating the extraction of the stone or the egress of the urine;
and what is also of prime importance, the external opening would
directly correspond with the incision through the prostate and neck of
the bladder. 2nd, After the incision through the skin and superficial
fascia is made, the operator should separate as many of the deeper
structures as will admit of it, by the finger rather than by the knife;
and especially use the knife cautiously towards the extremities of the
wound, so as to avoid the artery of the bulb, and the bulb itself in the
upper part, and the rectum below. The pudic artery will not be
endangered if the deeper parts be divided by the knife, with its edge
directed downwards and outwards, while its point slides securely along
the staff in the prostate. 3rd, The prostate should be incised
sparingly, for, in addition to the known fact that the gland when only
partly cut admits of dilatation to a degree sufficient to admit the
passage of even a stone of large size, it is also stated upon high
authority that by incising the prostate and neck of the bladder to a
length equal to the diameter of the stone, such a proceeding is more
frequently followed with disastrous results, owing to the circumstance
that the pelvic fascia being divided at the place where it is reflected
upon the base of the gland and the side and neck of the bladder, allows
the urine to infiltrate the cellular tissue of the pelvis. [Footnote]

[Footnote: "The object in following this method," Mr. Liston observes,
"is to avoid all interference with the reflexion of the ilio-vesical
fascia from the sides of the pelvic cavity over the base of the gland
and side of the bladder. If this natural boundary betwixt the external
and internal cellular tissue is broken up, there is scarcely a
possibility of preventing infiltration of the urine, which must almost
certainly prove fatal. The prostate and other parts around the neck of
the bladder are very elastic and yielding, so that without much solution
of their continuity, and without the least laceration, the opening can
be so dilated as to admit the fore-finger readily through the same
wound; the forceps can be introduced upon this as a guide, and they can
also be removed alon