Celsus, De Medicina
W. G. Spencer, Ed.

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[p. 437] so if a spinous stone sticks to the bladder, and when being drawn down has folded it over. Now it may be inferred that the stone is at the neck of the bladder, when the patient has difficulty in passing water: or that the stone is spinous, when he passes bloody urine in drops. And it is most important that the calculus should be felt under the fingers, and that the operation should not be proceeded with unless this is assured. And then too the fingers must be applied gently, lest they wound by pressing forcibly: the incision is then made. Many use a scalpel here also. Since this is rather weak, and may meet some projecting part of the stone, and while cutting the flesh over the projection fail to divide what is in the hollow beneath, but leave something which necessitates a second operation. Meges made a straight blade, with a wide border on its upper part, semicircular and sharp below. This knife, with its handle grasped between the two fingers, index and middle, and the thumb put into the back of the blade, was so pressed down that any projection upon the stone might be cut through along with the flesh. By this means it followed that he made one opening of a sufficient size. But in whatever way the neck of the bladder is laid open, any rough stone should be extracted gently, and no force used to hasten matters.

A sandy stone is made evident before the operation by the sandy urine which is passed, and in the course of it, since it does not present a uniform resistance to the fingers in the rectum, and in addition it breaks up. Again soft stones and those composed of numerous small ones which only lightly adhere together, are indicated when the urine