ded by raising the point of the
lithotrite immediately after grasping the stone and before crushing. The
stone breaks into two or more pieces, and these fragments must be
crushed, one by one, until they are powdered fine enough to escape by
the large evacuating catheter. If the stone be large and hard, half an
hour or longer may be required to crush it sufficiently fine. When the
surgeon fails to catch any more large pieces, the presumption is that
the stone has been thoroughly broken up. The lithotrite is then
withdrawn and the detritus is washed out by an "aspirator," which
consists of a stiff elastic ball which is connected with a trap, into
which fragments of stone fall so as not to pass out on the instrument
being used at later periods in the operation. A large catheter, with the
eye very near the end of the short curve, is passed into the bladder;
the aspirator, full of boracic lotion, is attached to the catheter, and
a few ounces of the fluid are expressed from the aspirator into the
bladder by squeezing the rubber ball. When the pressure is taken off the
ball, it dilates and draws the fluid out of the bladder, and with it
some of the detritus, which falls into the trap. This is repeated until
all the fragments have been removed. After the operation the patient
sometimes suffers from discomfort. His urine should be drawn off by a
soft catheter at regular intervals for a few days. If the pain be
severe, it can generally be relieved by fomentations. The patient must
be kept in bed after the operation, and in cases where the stone has
been large and the bladder irritable, the surgeon should insist on his
remaining there for at least a week; in those cases which go on
favourably the patients are soon able to perform their ordinary duties.
Fatal terminations, however, do now and again occur from suppression of
urine, the result of the old-standing kidney disease which so often
complicates these cases.

To Brigade-Surgeon Lieutenant-Colonel Dennis Francis Keegan, of the
Indian Medical Service, is due the fact that the operation of crushing
and promptly removing all fragments of a vesical calculus is as well
suited for boys as for men. In entire opposition to long-standing
European prejudices, Keegan's operation is now firmly and permanently
established. The old operation (Cheselden's) of cutting a stone out
through the bottom of a boy's bladder is now seldom resorted to, and if
a stone in a boy is found too large or to