Part of a Letter from Mr. George Howell, Surgeon, at Haverfordwest, to Mr. W. Watson, F. R. S. concerning the Extracting a Large Stone by an Aperture in the Urethra

1138. Ranunculus, aconiti folio, flore albo multiplo. *Ibid.* 1139. ———— pratensis, erectus, acris, flore pleno. *Ibid.* 1140. Rhus *Virginiana*, sparsa panicula ramis patulis glabris. *Hort. Elth.* 1141. Saxifraga pratensis, flore pleno. 1142. Smilax humillima unifolia. *Tourn.* 1143. Scabiosa peregrina, capite oblongo nigricante, Zibethi odore. *C. B.* 1144. Siliqua dulcis. *C. B.* & Off. 1145. Spiraea, Hyperici folio. *Tourn.* 1146. ———— Opuli folio. *Ibid.* 1147. ———— Salicis folio. *Ibid.* 1148. Tagetes minor, flore simplici striato. *Ibid.* 1149. Verbena tenuifolia. *C. B.* 1150. Xeranthemum flore albo pleno. *Hort. Lug. Bat.* --- **VIII. Part of a Letter from Mr. George Howell, Surgeon, at Haverfordwest, to Mr. W. Watson, F. R. S. concerning the extracting a large Stone by an Aperture in the Urethra.** *Read June 5, 1746.* JOHN COD, of the Parish of Roch, in the County of Pembroke, aged 40, was from his Infancy troubled with nephritic Complaints, and frequent Obstructions of Urine. He, at 25 Years of Age, had a total Suppression of Urine for some Days; when, upon a Stone’s rushing out of the Bladder into the Urethra, he had immediate Ease from his Pain; and was therefore negligent concerning its Extraction from thence. Five Years after, he married; the Stone remaining in the Urethra; which was then (as he imagines) about the Size of a Walnut. In the Space of four Years, his Wife brought him two Children. About that time he sent for me, and wanted me to dissolve the Stone; he having just then read some Treatises speaking largely of the Powers of lithontriptic Medicines. I told him, that, admitting the Power of the Dissolvents of the Stone might be very considerable, when the Stone was in the Bladder, and might be surrounded by the medicated Urine, very little was to be expected in the Posture the Stone then lay; but, if he was willing to have it cut out, I would undertake the Operation. This he would by no means consent to; and so we parted at that time. I heard no more from him for six Years. In August last I had a Message from his Family, desiring my Assistance, they believing him dying; he having had a total Suppression of Urine between three or four Days. Just as the Servant was coming with the Message, his Urine had forced a Passage through the superior Part, or Dorsum Penis, and had flowed out plentifully. Upon my coming to him, I proposed cutting out the Stone; his Answer was, he would submit to whatever I should think necessary; he being now convinced, that, if he were not speedily relieved, his Death would be inevitable. The whole Quantity of Urine, which was contained in the Bladder, had made its Way through the new Opening in the Back of the Penis; and therefore, at present, the Inflammation of the Penis being very violent, I deferred the Operation, and only applied a Fomentation and Cataplasm, to take off that Inflammation. I returned in two Days; and, by an Incision into the Urethra near three Inches long, I extracted the Stone, which had been there fifteen Years. It weighed two Ounces and half, and measured six Inches round, in the Direction it lay in the Penis. About fifty small Stones lay between this great one and the Bulb of the Urethra. These came forth from this Incision. After this, I put in five Pins, and made the twisted Suture, and then introduced a leaden Canula. The Urine passed regularly two Days; when an Inflammation came on, which tore out all the Stitches. I tried once more, and took the greatest Hold possible; but the Urethra was so tender, that my Endeavours to unite the Lips of the Wound were fruitless. The Man was glad to compound for Life, even with the Loss of the Penis, if that were necessary, which the Stone had increased to an enormous Bulk. But, after my attending and dressing him about two Months, the Orifice, through which the Stone was extracted, was reduced to half an Inch in Length from the Frænum backwards. But altho' I introduced a leaden Pipe near three Inches long into the Urethra, the Urine never came through the natural Orifice, but still continues to pass through the Aperture. The Passage in the Back of the Penis, made by the Urine before the Operation, heal'd up kindly. He has since been much rejoiced, that the Incision could not be healed, because he has lately voided several large Stones that Way; which he most probably must have been cut for again, had that been closed. For several Years his Urine did not drop, but by the Introduction of a knitting Needle, or such-like Instrument, which would move the Stone: And this Operation generally took up two Hours every Morning. You will see easily which Way the Stone lay in the Penis, by observing some Holes therein, which the Patient had made with the knitting Needle, hoping to push through it in time. These Holes are in the Fore-Part, or against the natural Orifice. The other End you will find quite polished, by the Friction of the small Stones against it. The Superior Part is like the Glans Penis: If you place the Stone upon a Table, and observe it at a small Distance, it seems not unlike a Glans cut off, only larger. I shall give you no further Trouble upon this Account; but shall only mention, that, a Fortnight after the Operation, his Wife was deliver'd of a third Child. She has the Character of a very virtuous Woman; but how the semen in coitu could pass by this Stone, when the Urine could not, but with such Difficulty, I do not pretend to determine.