If the stone is broken, the larger pieces should be extracted by the forceps, and the smaller with a scoop, rwards warm water is to be injected, and the patient raised to an upright posture. We think, however, that the anxiety for evacuating the smallest particles has been too great, and that their discharge may be safely trusted to the first flow of urine.

If an artery bleeds, it must be confined by a ligature; but if this is impracticable, a roller should be placed in the wound, preserving a passage for the urine by a canula. The body should then be raised, so that the wound may depend; and in this state the patient must be placed in bed.

The operation sometimes fails by the incision being made too far towards the urethra; for wounds in the urethra cannot facilitate the extraction of the stone; and, in these instances, the bladder is opened imperfectly, and the gorget slips into the cellular membrane. The urethra is indeed divided by the cutting gorget, with the neck of the bladder; but the perfection of the operation consists in making a fair and proper opening into the bladder itself. Sometimes, when the operator has not made a fair, bold incision, too much is trusted to the gorget, and the bladder is lacerated. We know from De Romanis' operation, that lacerations of the bladder are not always fatal, as well as from the lateral method, previous to the introduction of the cutting gorget. But there is much reason to believe that such lacerations are at least dangerous, and probably some of the fatal events may have been from the mortification subsequent to such violence.

Another error is carrying the incision too low, or in the lower part too near the raphe, by which the rectum is wounded, and the faeces afterwards constantly discharged from the wound. The error is not indeed fatal, but the future life is truly miserable. The place at which the proper incision must be made is indeed limited; but it is so nicely defined, that we have heard a professor declare he could perform the operation in the dark; and we once knew a celebrated operator who remarked, that he declined the operation, rather from the bluntness of his touch than of his sight.

After the operation tired nature sinks to rest; but from forty to fifty drops of laudanum are usually given to take off irritation. After a few hours, however, pains, apparently spasmodic, come on in the lower part of the abdomen. These are relieved by anodyne clysters and fomentations. Should the pain increase, and the belly become hard, the case must be treated like enteritis; but anodynes may be more freely given, and warm clysters frequently thrown up. The warm bath is in these circumstances often useful. In many cases, however, notwithstanding every care, mortification comes on, the wound appears foul and livid. In better circumstances it looks healthy; in a day or two the urine is discharged from the urethra, and a cicatrix is formed in about six weeks or two months. Incontinence of urine, which often follows, is relieved by tonics and cold bathing.

Calculus in females is by no means a common com-plaint, and the operation is rarely required. When the neck of the bladder and the urethra are opened from the vagina, great inconveniences occur in future labours, from the contraction induced by the cicatrices; but, when the operation is performed, these parts arc usually divided by the cutting gorget. We suspect that, in women, what is called the high or De Romanis' method would be most advisable; but as the urethra is so easily dilated, there are few stones that could not be extracted without cutting.

Mr. Bromfield describes the following method of dilating the urethra, apparendy better than by means of-tents. With the assistance of a straight, blunt, director, he introduced into the bladder the closed end of the apendicula intestini caeci of a small animal; and leaving out, at a proper length, the open end, he filled it with warm water by means of a syringe, and prevented the water's escape by a ligature. He then, by twisting the exposed end of the tube, forced the contained water forwards, and this operation was repeated from time to time, till the neck of the bladder was so much opened, that the forceps might have easily been admitted, if required. The stone, however, was propelled by the urine, and the instrument was not necessary. After the passage of the stone, the parts were fomented with warm milk, and with camphorated spirit of wine. Very little inflammation came on, and no disagreeable symptom. See his Observations and Cases, vol. ii.

Mr. Gooch extracted a stone of four ounces weight, through an incision which he made from the vagina into the bladder. This operation was attended with very little trouble, either to himself or the patient; the ulcer soon healed by the use of soft balsamic injections, and no inconvenience was observed after the healing of the parts. See Cases and Remarks, vol. ii. p. 182, etc.

Stones impacted in the urethra are often discharged by the efforts of nature, and it is frequently astonishing to what a degree the canal may be dilated./ Gentle means are therefore first necessary, and oily frictions, gentle pressure, with the semicupium, and large doses of opium, will often succeed. If an operation is required, the skin should be drawn forward, and the urethra divided on the stone. The skin, when restored to its former position, will prevent the urine from flowing through the wound, which will often heal by the first intention. The operation should not, however, be so long delayed as to allow inflammation to come on, for mortification would be the consequence. When the stone is impacted near the neck of the bladder, the operation is the same as cutting on the gripe. When near the orifice of the urethra, the canal may be dilated by elastic forceps. When near the scrotum, it should be eitner pushed backwards or forwards, and treated ac-coiaing to the plans already described.

See Sharp's Operations of Surgery. Sharp's Critical Enquiry. Heister's Surgery. Bromfield's Cases and Observations, vol. ii. ch. 8. Le Dran's Operations. Heister's Dissertation on the High Apparatus. Bell's Surgery, vol. ii. p. 41, etc.