THE EFFECT OF ANTISYPHILITIC TREATMENT AS GAUGED BY THE SIGMA REACTION

on opening the bladder to deviate the urine prior to an operation for hypospadias. There were 4 cases in wlhich litliolapaxy failed. In one of these the stone was composed of fibrin covered by a thin layer of phosphates; in another the patient was suffering from adlvanced tabes, and, although the stonie was easily crushed, the fragments could not be evacuated. The bladder was opencd, anid it was found that they had slipped through the relaxed sphincter vesicae into the posterior urethra. In the remaining 2 cases the cause of the failure was not mentioned. In 31 cases no definite reason was given in the niotes why lithotomy was performed instead of litholapaxy, but in all these cases foul cystitis was present, and it is probable that the bladder was opened in order to relieve the infection. The one case of perineal lithotomy was of interest. The patient had stones in both kidneys, in the right ureter, in the bladder, and in the urethra. As the urethral calculi could not be displaced back into tlle bladder, cxternal urethrotomy was performed, and the bladder stones were removed at the same time tlirough the urethral incision. From these figures it will be seen that litholapaxy is still considered the operation of choice for uncomplicated vesical calculus, and that the surgical staff of the hospital onlv resort to lithotomy when there is a definite contraindication to the crushing operation. In one sense only has the operation declined. Before the introduction of prostatectomy, litholapaxy was considered to be the correct treatment of stone complicating prostatic obstruction. The results in these cases were very bad, as it was practically impossible to exvacuate fragments which had fallen inito the postprostatic pouch, and recurrence was the rule and not the exception. No recurr ence due to imperfect evacuation of the fragments has been noted in the present series of 226 operations, and the mortality is only 2.2 per cent., so that the end-results are eminently satisfactory.-We are, etc., J. SWIFT JOLY.