termine
whether a stone exists in the bladder, let the patient take a warm
bath. Then let him be placed with his buttocks elevated, and, having
inserted into the anus two fingers of the right hand, press the fist
of the left hand deeply above the pubes and lift and draw the entire
bladder upward. If you find anything hard and heavy, it is manifest
that there is a stone in the bladder. If the body feels soft and
fleshy, it is a fleshy excrescence (_carnositas_), which impedes the
flow of urine. Now, if the stone is located in the neck of the bladder
and you wish to force it to the fundus: after the use of fomentations
and inunctions, inject through a syringe (_siringa_) some petroleum,
and after a short interval pass the syringe again up to the neck of
the bladder and cautiously and gently push the stone away from the
neck to the fundus. Or, which is safer and better, having used the
preceding fomentations and inunctions, and having assured yourself
that there is a stone in the bladder, introduce your fingers into the
anus and compress the neck of the bladder with the fist of the left
hand above the pubes, and cautiously remove the stone and guide it
to the fundus. But if you wish to extract the stone, let a spare diet
precede the operation, and let the patient lie abed for a couple of
days with very little food. On the third day introduce the fingers
into the anus as before, and draw down the stone into the neck of
the bladder. Then make your incision lengthwise in the fontanel, the
width of two fingers above the anus, and extract the stone. For nine
days after the operation let the patient use, morning and evening,
fomentations of _branca_ (_acanthus mollis_), _paritaria_ (pellitery)
and _malva_ (mallows). A bit of tow (_stupa_) moistened with the yolk
of egg in winter, and with both the yolk and white of egg in summer,
is to be placed over the wound. Proud flesh, which often springs up
near a wound in the neck of the bladder, should be removed by the
knife (_rasorio_), and two or three sutures inserted. The wound is
then to be treated like other wounds. It should be remarked, however,
that if the stone is very large, it should be simply pushed up to the
fundus of the bladder and left there, and no effort should be made to
extract it."

This description of the diagnosis of stone and of the operation of
lithotomy is copied almost literally from Roger of Parma.

Sufficient (perhaps more than enough) has been written to