to make water.  If this treatment turns out in accordance with your theory, the urine necessarily escapes and your idea and treatment are confirmed.  If, however, the urine not escape, let the boy be shaken vigorously a second time.  If this 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: