his too fails and strangury ensues, it will be
necessary to resort to the use of a sound or catheter (_argaliam_),
so that when the stone is pushed away from the neck of the bladder the
passage may be opened and the urine may flow out. It may be possible
too that no stone exists, but the urethra is obstructed or closed
by pure coagulated blood. Perhaps there may have been a wound of the
bladder, although no external haemorrhage has appeared, but the blood
coagulating gradually in the bladder has occasioned an obstruction or
narrowing of the urinary passage. Or possibly the blood from a renal
haemorrhage has descended into the bladder and obstructs the urethra.
Hence I say that the sound is useful in these cases where the urethra
is obstructed by blood or gross humors. Examination should also be
made as to whether a fleshy body exists in the bladder, as the result
of some wound. This condition is manifest if, on the introduction of
the sound, the urine flows out promptly. I once saw a man suffering
from this condition, who complained of severe pain in the urinary
passage as I was introducing the sound, and I recognized that there
were wounds in the same part, for as soon as these were touched by
the sound the urine began to flow, followed soon after by a little
blood and fleshy particles.... So far as the operation of physicians
is concerned, it is necessary only to be certain of the fact that
obstruction to the passage of urine depends upon no other cause than
stone or the presence of coagulated blood (f. 271).

Gilbert's medical treatment of vesical calculus consists generally
in the administration of diuretics and lithontriptics and the local
application of poultices, plasters and inunctions of various kinds.
Of the lithontriptics, certain combinations, characterized by famous
names or notable historical origin, are evident favorites. Among
this class we read of the _Philoantropos major_ and _minor_, the
_Justinum_, the _Usina_ "approved by many wise men of Babylon and
Constantinople," the _Lithontripon_ and the "_Pulvis Eugenii pape_,"
with numerous others.

Rather curiously and suggestively no mention is made in this immediate
connection of the technique of lithotomy. On a later page, however (f.
309a), we find a chapter entitled "_De cura lapidis per cyrurgiam_,"
in which Gilbert writes:

"Mark here a chapter on the cure of stone in the bladder by means
of surgery, which we have omitted above. Accordingly, to de