o hard to lend itself to the
crushing operation, it is removed by a vertical incision through the
lower part of the anterior wall of the abdomen, as described above. For
a successful performance of the crushing operation in a boy a small
lithotrite has, of course, to be used, and it must be of the very best
English make. The operation has to be done with the utmost gentleness
and thoroughness, not a particle of the crushed stone being left in the
bladder, since otherwise the piece left becomes the nucleus of a fresh
stone and the trouble recurs.

The treatment of vesical calculi by other means than operative surgery
is of little value. Attempts have been made to dissolve them by internal
remedies, or by the injection of chemical agents into the bladder; but,
although such methods have for a time been apparently successful, they
have invariably been found worthless for removing calculi once actually
formed. Nevertheless, much can be done towards _preventing_ the
formation of calculi in those who have a tendency to their formation, by
attention to diet, by taking proper exercise, and by the internal
administration of drugs.

_Rupture of the bladder_ may be caused by a kick or blow over the
upper part of the abdomen, or by a wheel passing over it; or it may be
a complication of fracture of the pelvis. If the rupture is in that
part of the bladder which is uncovered by the peritoneum, the
extravasated urine may be cut down upon and let out with good prospect
of success; but if the rupture is in the upper or hinder part of the
bladder the urine is let loose into the general peritoneal cavity and
sets up peritonitis, which is more than likely to prove fatal. If the
surgeon knows that the bladder is ruptured he should operate at once
in order to provide escape for the urine, and also to sew up the rent.
If the possibility of the bladder being ruptured be even suspected,
the surgeon should pass a catheter. Perhaps he draws off an ounce or
two of blood-stained urine. This makes him doubly suspicious, so he
injects into the bladder five, eight or ten ounces of warm boracic
lotion, and, leaving it there for a few minutes, he measures the
amount which he is able afterwards to withdraw; if he finds that a
certain amount is lost he is assured that a leakage has taken place
and he at once proceeds to operate. If only the diagnosis is made
promptly, and the operation is at once undertaken, the out