tic lobes are enlarged, and appear
contracting the vesical orifice. In the walls of the bladder are
embedded several small calculi, 2, 2, 2, 2, which, on being struck with
the convex side of a sound, might give the impression as though a single
stone of large size existed. In performing lithotomy, these calculi
would not be within reach of the forceps.

[Illustration]
Plate 64,--Figure 5.

FIG. 6, Plate 64.--Two sacculi, 4, 5, appear projecting at the middle
line of the base of the bladder, between the vasa deferentia, 7, 7, and
behind the prostate, in the situation where the operation of puncturing
the bladder per anum is recommended to be performed in retention of
urine.

[Illustration]
Plate 64,--Figure 6.

FIG. 7, Plate 64.--A sac, 4, is situated on the left side of the
bladder, 3, 3, immediately above the orifice of the ureter. In the sac
was contained a mass of phosphatic calculus. This substance is said to
be secreted by the mucous lining of the bladder, while in a state of
chronic inflammation, but there seems nevertheless very good reason for
us to believe that it is, like all other calculous matter, a deposit
from the urine.

[Illustration]
Plate 64,--Figure 7.

FIG. 8, Plate 64, represents, in section, the relative position of the
parts concerned in catheterism. [Footnote] In performing this operation,
the patient is to be laid supine; his loins are to be supported on a
pillow; and his thighs are to be flexed and drawn apart from each other.
By this means the perinaeum is brought fully into view, and its
structures are made to assume a fixed relative position. The operator,
standing on the patient's left side, is now to raise the penis so as to
render the urethra, 8, 8, 8, as straight as possible between the meatus,
a, and the bulb, 7. The instrument (the concavity of its curve being
turned to the left groin) is now to be inserted into the meatus, and
while being gently impelled through the canal, the urethra is to be
drawn forwards, by the left hand, over the instrument. By stretching the
urethra, we render its sides sufficiently tense for facilitating the
passage of the instrument, and the orifices of the lacunae become
closed. While the instrument is being passed along this part of the
canal, its point should be directed fairly towards the urethral opening,
6*, of the triangular ligament, which is situated an inch or so below
the pubic symphysis, 11. With this object in view, we should av