AFTER-TREATMENT FOR CYSTIC CALCULI. 
363 
become so closely applied to the calculus that the greatest difficulty is 
experienced in seizing the latter. As soon as a hard body is felt the 
forceps are opened, and an effort made to seize the stone. A hand in the 
rectum may prove of considerable assistance in grasping the stone. Once 
grasped, the forceps are rotated around their long axis to make sure that 
the mucous membrane has not been included; and if no great resistance 
is felt the stone is drawn forward and removed, the rush of urine which 
takes place assisting the process. The instrument should be reinserted 
or the bladder examined from the rectum, to make certain that no othei 
calculus or gravel is present, which would require 
removal or washing out, otherwise one proceeds as in 
urethrotomy. Suturing the wound is not absolutely 
necessary, though it somewhat hastens recovery; but 
if unskilfully performed, so that the urethra is left 
open while the skin is closed, infiltration of urine 
occurs and leads to grave consequences. Healing 
occurs in the same time as in urethrotomy. For a 
short time urine escapes in part by the operation 
wound; but this soon closes, and only occasionally 
does urethral fistula result. 
After-treatment consists in washing out the bladder 
once daily with a lukewarm saturated solution of boric 
acid or a 2 per cent, solution of acetate of alumina, 
by means of a rubber tube. This prevents decompo¬ 
sition of urine. If treatment must be left to laymen, 
a tube mav be fixed in the urethra, otherwise the 
practice should be condemned as favouring infection of 
the bladder. The tube must be cleansed or placed for 
a short time before insertion in the lotion to be injected. 
In removing large stones, the neck of the bladdei 
must sometimes be enlarged to such an extent as to iio. 
admit the entire hand. After incision of the con¬ 
strictor urethrae Moller once removed a cystic calculus weighing over 
20 ounces. The bladder must not be completely emptied, however, as its 
walls cling to the stone and render extraction difficult. If such an accident 
has happened, lukewarm fluids, like 5 per cent, carbolic lotion, may be 
injected, but are not always retained, particularly where the opening 
resulting from division of the constrictor urethrae is of great size. 
The danger of operation increases with the size of the calculus, though 
stones of considerable magnitude may be safely removed, as shown by 
Moller extracting two calculi from the bladder of a nine year old gelding, 
one weighing 2J ounces and the other 20J ounces. The operation wound 
took three weeks to heal. In a second horse from which he took a stone 
