peration the patient, being duly
prepared, is placed upon his back and the bladder is washed out with hot
boracic lotion, and when the lotion returns quite clean a final
injection is made until the bladder is felt rising above the pubes. Then
the india-rubber tube is removed from the silver catheter by which the
injection has been made, and the end of the catheter is plugged by a
spigot. An incision is then made in the middle line of the abdomen over
the bladder region. The incision must be kept as low as possible, so
that the bladder may be reached below the peritoneum, which, higher up,
gives it an external, serous coat. As the bladder is approached, a good
many veins are seen to be in the way, some of which have to be wounded.
The bladder-wall is recognized by its coarse network of pale muscular
fibres, through which, on each side of the middle line, a strong suture
is passed, so that when the bladder is opened and the lotion comes
rushing out, the opening which has been made into the bladder may not
sink into the depths of the pelvis. A finger introduced into the bladder
makes out the exact size and position of the stone, or stones, and the
removal is effected by special forceps. Bleeding having ceased, the
bladder-wound is partly or entirely closed by sutures and allowed to
fall into the pelvis, the catheter having been removed. It is advisable
to leave a drainage tube in the abdominal wound for a while, so that if
urine leaks from the bladder-wound it may find a ready escape to the
dressings.

_Litholapaxy_.--Lithotrity consists of two parts--the crushing of the
stone, and the removal of the detritus. The two stages are now carried
out at one "sitting," without an interval being allowed between them, as
was formerly the practice, and the term "litholapaxy" designates this
method. The patient having been anaesthetized, 10 oz. of hot boracic
lotion are injected, and the crushing instrument, the lithotrite, is
then passed into the bladder. The lithotrite has two blades, a "male"
and a "female," the latter fenestrated, the former solid with its
surface notched. When the stone is fixed between the blades the screw is
used, and great pressure is applied evenly, gradually and continuously
to the stone. The lithotrite is made of very tough steel, so that hard
stones may be crushed without danger of the instrument breaking or
bending. Care must be taken not to catch the bladder-wall with the
lithotrite. This danger is avoi