The lateral operation is described by Mr. Sharp in the following words from Mr. Cheselden:"the patient being laid on a table, with his hands and feet tied, and the staff passed, as in the old way, let your assistant hold it a little slanting on one side, so that the direction of it may run exactly through the middle of the left erector penis and accelerator urinae muscles; then make your incision through the skin and fat, very large, beginning in one side of the seam in perinaeo, a little above the place wounded in the old way, and finishing a little below the anus, between it and the tuberosity of the ischium. This wound must be carried on deeper between the muscles, till the prostatas can be felt, when searching for the staff, and fixing it properly if it had slipped, you must turn the edge of the knife upwards, and cut the whole length of that gland from within outwards, at the same time pushing down the rectum with a finger or two of the left hand, by which precautions the gut will always escape wounding; after this, introduce the foreceps to take out the stone. After the operation is ended, if there is an haemorrhage from the prostate gland, a silver canula of three or four inches long, covered with fine rag, may be introduced into the bladder, and left there two or three days; for it rarely fails to check it: - the patient may also take an opiate. If the wound does not bleed, a little dry lint, or a pledget of digestive, may be laid in it. If a pain is felt near the bladder soon after the dressings are finished, a bladder of warm water may be applied over it; and if it increases, as there, will be much danger therefrom, bleeding and clysters will be necessary."

The present improved practice demands, however, a minuter detail. When a stone has been discovered by the sound, and the operation is determined on, every source of irritation must be removed. The patient, if plethoric, should be bled, the bowels emptied by mild, but sufficiently active, laxatives, interposing a dose or two of calomel, and giving some doses of helleboras-ter to evacuate worms, should any be present. The warm bath and opiates are advised occasionally, but are apparently unnecessary. The diet should be light and mild, and diluent liquors drunk freely. It is recommended that the bladder be moderately filled previous to the operation, that, in the incision, the exterior part only should be wounded: but as the incision is made on the staff, this appears to be an useless refinement.

The patient is placed on a table, about three feet high, and bends forwards so as to take each foot in the corresponding hand; the wrists and ankles are respectively confined by a broad tape. The buttocks are then, by pillows, raised above the shoulders, and brought forward a little beyond the table.

The sound is introduced, and the stone again sought for. If it was before certainly discovered, though it should not be at this time found, the operation generally proceeds; but if the slightest doubt existed in the previous searches, and it cannot now be felt, a prudent surgeon will defer the operation. If it be determined to proceed, the surgeon makes an incision from the symphysis of the pubes, just below the scrotum, downwards and outwards to the part between the anus and the tuberosity of the ischium, a little below the basis of the process. His next incision he carries nearer the raphe and anus, to avoid dividing the pudica. He thus divides the transversalis penis and part of the levator ani, so as to enable him to feel the prostate. He must guard against cutting the crura penis, which he can easily feel, and the rectum, which is best secured by introducing a finger into it.

He must now feel for the grooved staff, which his assistant must keep against the side of the raphe, by pressing its handle back against the right side of the patient's abdomen. The operator must find the staff steadily opposed to him, from the bulb of the urethra to the prostate gland, and on this he must cut, from below upwards, till the staff can be felt perfectly bare, and the incision will admit the finger, which not only keeps the parts stretched, but guards the rectum from injury.

The next step is to divide the prostate gland and the neck of the bladder. This is sometimes performed by the knife, but the gorget, or, as the French call it, the gorgeret, is employed for the purpose. Its beak is fitted to the groove of the staff, and along it this hollow conical instrument was forced into the bladder, tearing in its passage the neck of the bladder and the prostate, till Mr. Hawkins bent the edges a little more outwardly, and gave them an edge. This cutting gorget is now preferred. As the groove in the staff is continued to its end, the beak of the gorget slides easily off; and this part of the operation is so nice and important, that the operator usually chooses to manage both instruments himself.

When the gorget is in the bladder, the urine flows out, and the operator usually attempts to feel for the stone with his finger. Whether he can discover it or not he introduces the forceps, and attempts to take hold of it; opening the forceps when he perceives them touch the stone, and cautiously sliding a blade under the stone, the other is of course over it. The forceps are rough at the hollows, and finely polished between these and the rivet, so that if the stone comes near the latter, it slides to the former. The operator must hold the stone with sufficient firmness to prevent its sliding, but not so closely as to break it, if brittle, and must extract it slowly and steadily. In general, one blade of the forceps should be under the symphysis of the pubes, and the other obliquely below. When the stone is small, it often falls below the line of the instrument; and, in this case, some operators recommend bent forceps, but it is better to introduce the finger into the rectum to raise the stone, for by the bent for-ceps the bladder is often injured. Should the blades of the forceps appear distant, it is probable that the stone is large, or that it is held disadvantageously . The last is most frequently the case, and the operator should therefore loosen his hold in order to take it in a more convenient position. It has scarcely ever happened that the stone is too large to be extracted, if drawn forward cautiously, assisted by the finger. Should it slip and fall back at the edge of the wound, the sound and the gorget must be again introduced to guide the forceps.