The method of De Romanis, or with the greater apparatus, was suggested by the facility with which stones are extracted from the female bladder, in consequence of the greater size of the urethra, and its running in a less curved direction. He supposed that if the urethra in men could, by any operation, be so far curtailed, as to resemble this canal in women, the operation would be equally easy. This method was discovered about the year 1520, but not publicly described by Marianus till fifteen years afterwards. We are expressly told, that the urethra must be divided from a little above its curvature, till the incision reaches the curvature. Then the urethra is strait and dilatable. It is consequently dilated by proper instruments, and the stone extracted. The plan appears plausible, but it seems, on. the whole, impracticable to extract a large stone in this way; and we are led to suspect that De Romanis, under the pretence of dilating the urethra, really divided the neck of the bladder. \Vhether he was aware of this division, and dared not direct it, since Hippocrates had spoken of wounds in the bladder as fatal, Aphor XVIII. lib. vi., and Celsus had repeated the observation, V. xxvi. or that it was an accident which accidentally followed, is uncertain. Le Dran, however, found, on dissection, that, in almost every instance, the neck of the bladder was split or divided; and Falconet, with other authors, have contended, that this division was intended, though dilatation only was described.

The inconveniences of this operation are too obvious to be detailed. Were dilatation only meant, the effect of this violent and continued distention would be incontinence of urine. Were laceration, as must be very often the case, to take place, mortification would generally ensue, and such we find was frequently the consequence. At least, the greater number of patients died; and these fatal events gave an importance to the improvement first attempted by Frere Jacques. But one other operation was previously suggested.

Peter Franco, already mentioned, operating on a child of two years old, found the stone too large to be removed through the wound; accident suggested the possibility of opening the bladder above the pubes, which he effected, and extracted the stone with success. Yet alarmed, apparently, at his own temerity, he never repeated the attempt, and dissuaded his followers from the operation. Even candour might suggest that he really failed; but, when it was recollected that, just above the pubes, the peritonaeum did not cover the bladder, and that, of course it might be opened, without opening the cavity of the abdomen; when to this was added, that the bladder, when dilated, rose far above the pubes, and that a wound might be safely made of an extent to extract any stone which might be contained in that cavity; it did not appear to be a very extravagant attempt. In fact, after Hildanus, Riolan. Dionis, and others, had given a reluctant consent to the trial, and admitted its safety, it was often attempted, before it was publicly recommended, by James and John Douglass, and practised by the latter, by Heister, by Cheselden, and others, in the former part of the eighteenth century.

There are many objections to this method; but, on again going over the subject in the original authors, for the purposes of this short history, we were surprised to find them so few and inconsiderable. It is certainly not necessary to distend the bladder very considerably; yet, on the whole, it is expedient to do so, and to retain the urine for a time longer than usual, several days previous to the operation, to give the bladder greater facility of distention. The distention need not, however, be so great as to injure its tonic power. The operation indeed, for reasons which we cannot explain, has not usually succeeded, when the patient has exceeded the age of thirty, or in those whose bladders are small. When the kidneys are diseased also, it is said that the modern method succeeds better. A singular and unexpected inconvenience, however, which the advocates of this operation endeavour to elude, is the difficulty of healing the wound. The muscular fibres of the bladder are circular, more thick and strong round the sphincter, in fact, thus forming the sphincter itself. When the distention of the bladder, therefore, excites the action of its fibres in general, the resistance is less at the wound above than at the sphincter below; and, indeed, it is so little at the wound, that when the high operation has followed, at the interval of a day, the puncture through the perinaeum, the urine is discharged above. The dressings are, therefore, constantly wet, and the wound soon becomes fistulous.

But whatever may have been the advantages or inconveniences, they have all yielded to the operation proposed by Frere Jacques, whose name it has been said was Beaulieu, and who came to Paris in 1697, from the provinces, destitute of money, clothes, and victuals. He was of an open, ingenuous temper, great simplicity of manners, requiring only what would repair his instruments and mend his shoes. His operation is that which we shall soon describe as the lateral, but his instruments were coarse, often a razor, or a common penknife; his manner rash and violent, without any fixed plan, or any knowledge of the anatomy of the parts. He soon lost his credit at Paris, and repaired to Holland, where he scarcely succeeded better; but we find him in Germany, fifteen years afterwards, greatly improved, and very successful. It is said, that he had been the servant of an itinerant practitioner.

(From whom he had learned the art, which, from want of anatomical knowledge, he was unable at first to practise with advantage.

The physicians of Paris, though they did not treat the good friar with much candour, artfully availed themselves of his hint. The same operation was supported by Meri, but first practised by Mareschal. The lateral operation was soon improved by Rau of Amsterdam, by Heister, and Cheseldcn; and, in its present state has superseded the three former. On this account we have not described them more particularly; but it was necessary, in giving a general view of the subject, to notice the attempts and errors of others. If our readers derive from this comprehensive sketch as much entertainment and improvement as the author has done, they will not regret the little time they will have employed in the perusal. .