Book 7 — NOTES TO BOOK VII.

Then, with respect to the transverse incision made through the neck of the bladder, some have thought that the word transverse was used as it regarded the first wound, so that the second incision was nearly perpendicular to the first, and the urethra was divided longitudinally; others again have supposed, that the incision was made transverse, with regard to the course of the urethra, that is, the neck of the bladder was opened transversely.

Though all the printed copies agree in the above reading, yet Morgagni informs us that instead of Qua strictior ima plaga est, his ancient MS has Qua resima plaga est, which would determine the convexity of the lunated incision to be towards the rectum; because in that case the cornua of the lunated incision would point to the superior part of the body. But this reading does not fix the direction of the plaga transversa, whether it was called so in respect of the parts, or the first incision: nor does that ingenious author favour us with his own opinion, but seems to prefer this to the common reading. Ep. vii. p. 189.

Now it should seem almost certain, that the lunated incision was meant to be concave towards the rectum; because when made in that direction, it would probably render the rectum much more loose and supple, than it is in its natural state, and thereby greatly facilitate the operation, by allowing the surgeon a much freer use of the two fingers, which are introduced into the rectum, and consequently admitting him to bring the stone more easily forwards into the neck of the bladder. One would suppose, however, that the benefit here suggested to arise from this lunated incision, was not extremely evident, or it would not have been dropped so early by succeeding surgeons: Ægineta makes not the least mention of this process, nor do we know when it was first discontinued. Perhaps, even in Celsus’s time, there were different methods of performing this operation; for does not he himself, when describing Meges’s manner of cutting upon a rough stone, omit the lunated incision? And does he not imply that there were different methods by saying, Quocunque autem modo cervix ea parte secta est, &c.?

With regard to the transversa plaga, it should seem by the use of that term, when he describes the manner of cutting women, that it was transverse with respect to the perineum; and indeed, it is natural to suppose, when the stone was brought forward by the fingers, and the neck only of the bladder was to be cut, that the incision should be made in that direction. But those, who contend that the transversa plaga was made transverse with respect only to the first incision, may urge, that Celsus in this very passage orders the incision of the neck of the bladder to be made so large, that the opening in the iter urinæ may exceed the dimensions of the stone. If, therefore, Celsus in this place intends that the urethra should be opened, one would suppose the incision must be made according to the length of that canal; but I believe it may be questioned, whether Celsus is sufficiently accurate in his notions of the anatomy of these parts, to determine his meaning by that expression.

It is very remarkable, that how much soever this operation of Celsus’s may have engaged the attention of later ages, neither Galen, Oribasius, nor Ægineta make the least mention of his method: nay Ægineta (lib. vi. cap. 60.) describes the cutting on the gripe nearly as it has been practised in our own age.