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There are but two operative methods now considered practical for the treatment of stone in the urinary bladder. One is the crushing of the stone and the removal of the fragments through the urethra; the other is the opening of the bladder suprapubically and the removal of the stone through the incision. He would be obdurate indeed who did not acknowledge the wonderful invention of the lithotrite and the achievements accomplished by its inventor. At a time when any cutting operation carried with it such a high mortality and the convalescence was so prolonged in those who survived, the lithotrite, with the skilful touch of Bigelow, was truly a blessing; but the conditions that prevailed then with regard to the cutting operation no longer exist to-day. Little advancement, if any, has been made for the crushing operation, while each year brings a better record for the suprapubic operation. To say

Case 192. —An Arab from the Plains, about 55 years of age, came to the hospital April 17, complaining of pain in urinating; had suffered for some time, as many scars of the hot iron over the region of the bladder testified. He was of good build, fairly nourished, but had a terrible dread of the knife, and would not listen to the operation by lithotomy. I explained to him that if the stone was sufficiently friable I could remove it without cutting, provided it was not too large to be grasped by the lithotrite. So on those conditions he became an inmate of the hospital, and the work of crushing began. The stone was found to be very large, but I was able to grasp and crush portions of it. After crushing as much as I thought advisable at one sitting, I proceeded to withdraw the lithotrite (Thompson's), which

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