Celsian Method (Apparatus Minor)
Only two instruments needed
This procedure was known as the Lesser Operation or operation by the Apparatus Minor as only two instruments were essential, a knife and a hook. In England it became known as "Cutting on the Gripe". The median perineal approach is described below:
A strong and intelligent person being seated on a high stool, lays hold of the patient in a supine posture, with his back towards him, and his hips being placed on his knees, with his legs drawn backwards he orders the patient to seize his own hams with his hands, and to draw them towards his body with all his power, and at the same time he secures them in that position. Then the physician, having carefully pared his nails, introduces his index and middle fingers of the left hand, first the one gently, afterwards the other into the anus, and places the fingers of his right hand lightly on the lower part of the abdomen. First of all the stone must be sought for about the neck of the bladder and when it has been brought into that position a lunated incision must be made through the integuments immediately over and extending to the neck of the bladder near the anus, with the horns a little inclined towards the ischia; then a second incision is to be made in the transverse form in the convex part of the wound so as to open the neck of the bladder.
The stone was then extracted with a hook.
The original transverse incision was altered later to a vertical one, the breadth of a grain of wheat to the left of the median raphe. Persistent haemorrhage after operation was treated by sitting the patient in strong vinegar and salt.
The rectum was sometimes damaged and post-operative incontinence of urine was common.
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