ressed by a hand on the lower part of the abdomen. The
_cystoscope_ is a straight, hollow metal tube about the size of a long
cedar pencil, which the surgeon introduces into the adult bladder, which
has already been filled with warm boracic lotion. Down the tube run two
fine wires which control a minute electric lamp at the bladder end of
the instrument. At that end also is a small glass window which prevents
the fluid escaping by the tube, and also a prism; at the other end of
the tube is an eye-piece. By the use of this slender speculum the
practised surgeon can recognize the presence of tubercle or tuberculous
ulceration of the bladder, stone, or other foreign material, and
innocent or malignant growths. He can also watch the urine entering the
bladder by the openings of the ureters, and determine from which kidney
blood or pus is coming.

The _treatment_ of stone in the bladder is governed by various
conditions. Speaking generally, the surgeon prefers to introduce a
lithotrite and crush the stone into small fragments, and then to flush
out the fragments by using a full-sized, hollow metal catheter and an
india-rubber wash-bottle. Even in children this operation may generally
be adopted with success, the stone being crushed to atoms and the
fragments being washed out to the last small chip. But if the stone is
a very hard one (as are some of the oxalate of lime calculi), or if it
is very large, or if the bladder or the prostate gland is in a state of
advanced disease, or if the urethra is not roomy enough to admit
instruments of adequate calibre, the crushing operation (_lithotrity_)
must be deemed unsuitable, and the stone must be removed by a cutting
operation (_lithotomy_).

_Lithotomy_.--Cutting for stone has been long practised; but up to the
beginning of the 19th century it was performed only by a few men, who,
bolder than their contemporaries, had specially worked at that operation
and had attained celebrity as skilful lithotomists. Patients went long
distances to be operated on by them, and certain of the older surgeons,
as William Cheselden, performed a large number of operations with most
excellent results. The operation was by an incision from the perineum,
and is ordinarily spoken of as _lateral_ lithotomy. It was splendidly
designed, and gave good results, especially in children. But it is now a
thing of the past, having almost entirely given place to the _high_ or
_supra-pubic_ operation. In the high o