g with a stone of considerable dimensions, say from
three to nearly five inches in circumference, in one direction, and from
four to six in the largest."--Practical Surgery, page 510. This doctrine
(founded, no doubt, on Mr. Liston's own great experience) coincides with
that first expressed by Scarpa, Le Cat, and others. Sir Benjamin Brodie,
Mr. Stanley, and Mr. Syme are also advocates for limited incisions,
extending no farther than a partial division of the prostate, the rest
being effected by dilatation. The experience, however, of Cheselden,
Martineau, and Mr. S. Cooper, inclined them in favour of a rather free
incision of the prostate and neck of the bladder proportioned to the
size of the calculus, so that this may be extracted freely, without
lacerating or contusing the parts, "and," says the distinguished
lithotomist Klein, "upon this basis rests the success of my operations;
and hence I invariably make it a rule to let the incision be rather too
large than too small, and never to dilate it with any blunt instrument
when it happens to be too diminutive, but to enlarge it with a knife,
introduced, if necessary, several times."--Practische Ansichten der
Bedeutendsten Chirurgische Operationen. Opinions of the highest
authority being thus opposed, in reference to the question whether free
or limited incisions in the neck of the bladder are followed
respectively by the greater number of fatal or favourable results, and
these being thought mainly to depend upon whether the pelvic fascia be
opened or not, one need not hesitate to conclude, that since facts seem
to be noticed in support of both modes of practice equally, the issue of
the cases themselves must really be dependent upon other circumstances,
such as the state of the constitution, the state of the bladder, and the
relative position of the internal and external incisions. "Some
individuals (observes Sir B. Brodie) are good subjects for the
operation, and recover perhaps without a bad symptom, although the
operation may have been very indifferently performed. Others may be
truly said to be bad subjects, and die, even though the operation be
performed in the most perfect manner. What is it that constitutes the
essential difference between these two classes of cases? It is,
according to my experience, the presence or absence of organic
disease."--Diseases of the Urinary Organs.]

The position in which the staff is held while the membranous urethra and
prostate a