of the kidneys, and fourth died as the result of the operation. Of the four operated upon by litholapaxy or lithotrity with rapid evacuation, three made an excellent recovery, with no untoward complications whatever, and one died, as the result of injury to the prostate. In comparing the two methods of crushing, with and without rapid evacuation, it must seem to you that the one performed and accomplished at one sitting is decidedly preferable to repeated crushings and sharp fragments, not small enough to pass through the urethra, left to roll around in the bladder. The only question in the way-is the bladder susceptible of prolonged tolerance of manipulation? The data upon that point since Bigelow first published cases, are fully corroborated by the profession.

Dr. Keyes, in a paper on Rapid Lithotrity with evacuation, in the April No. of Amer. Journal of the Medical Sciences for 1880, says, in speaking of the statistics and mortality, that as far as he is aware, up to Feb. 15, '80, there have been one hundred and seven operations by this method with only six deaths. Bigelow in one case continued his manipulations three and three-quarter hours, and in one week after the patient was discharged well.

The points to be considered in this operation are:

1st. The selection of the case to be operated upon. This will depend upon the size of the urethra being sufficiently large to admit the passage of the evacuating tube, also upon the size of the stone to be crushed, and any stone that can be grasped by the blades of the instrument can be crushed. Cystitis is not necessarily in the way of the operation, for a number of cases, where cystitis has been extensive and of long standing, have terminated happily. It is to be presumed that all operators will take into consideration the general condition of the patient, particularly as to renal complications.

2d. A perfect knowledge of the anatomy of the parts, and the accustomed use of urethral instruments. Bigelow, Van Buren, Keyes, Gouley, and others emphatically state the operation should never be performed by any one not having these qualifications, and if no other opportunity presented, to practice it on the cadaver.

3d. The dangers attending the operation,-on injuries to the bladder and urethra. Injury, however, to the bladder is not of very great importance, as it will act nicely after injury when empty and at rest. But not so with deep urethra, for it is a marked fact that any injury to the membranous and prostatic urethra are quite often attended with unpleasant results. The reports of deaths after this operation are mainly

attributed to injury of the urethra, as revealed by post mortem examination.

The details of the operations are as follows: Perform, when possible, the operations upon a table of a convenient height; yet the apparatus is so constructed that it can be accomplished with the patient in bed. Two assistants are necessary,-one for the ether, and the other to attend to the washing bottle. Some operators prefer a quantity of water in the bladder before introducing the lithotrite. Some difficulty may be met with in keeping it in the bladder; this, however, can be done away with by applying a rubber band over the penis before introducing the instrument. Carbolated water is preferable, at a temperature of the body. The time of using the lithotrite will depend upon the size of the stone, and will depend upon the judgment of the operator,-probably 6 to 10 times opening and closing the blades will be sufficient. The evacuating tube is then introduced and attached to the rubber tubing and the connection established, when a gentle pressure is exerted upon the bulb, throwing the water into the bladder, and suddenly letting go the bulb when the sucking process commences, and the fragments will be seen to drop in the receiver below. This maneuver is sufficiently repeated until the fragments cease to drop, or the bulb ceases to expand. This may be due either to a large fragment or a part of the mucous membrane becoming engaged in the orifice of the tube. Changing the position of the tube, or a sudden pressure upon the bulb will be sufficient to displace it. It may be necessary to again introduce the lithotrite and crush the fragments that escaped the previous crushing. Occasionally these fragments, may escape the jaws of the instrument; and the maneuver, as suggested by Dr. Keyes, by turning the patient on his side with a full bladder, will roll the fragment or stone out of a pouch or sac, and permit of its being seized.

OFFICERS OF THE SOCIETY.

PRESIDENT-J. R. THOMAS, M. D., BAY CITY.

FIRST VICE PRESIDENT-E. P. CHRISTIAN, M. D., WYANDOTTE. SECOND VICE PRESIDENT-J. W. HAGADORN, M. D., LANSING. THIRD VICE PRESIDENT-C. J. LUNDY, M. D., DETROIT. FOURTH VICE PRESIDENT-J. H. BENNETT, M. D., COLDWATER. RECORDING SECRETARY-GEO. E. RANNEY, M. D., LANSING. TREASURER-G. W. TOPPING, M. D., DEWITT.

STANDING GOMMITTEES.

EXECUTIVE.

DR. HORACE TUPPER, BAY CITY. DR. L. W. BLISS, SAGINAW CITY.
C. V. TYLER, BAY CITY.
WM. L. DICKINSON, E. SAGINAW.

ON PAPERS AND SUBJECTS FOR DIS

CUSSION.

1st.-Practice of Medicine.

DR. C. T. SOUTHWORTH, MONROE. DR. GORDON CHITTOCK, JACKSON. T. D. BRADFIELD, G’D RAPIDS. LOUIS FASQUELLE, ST. JOHNS.

Committee to Report upon the Communication from the Woman's Temperance Union.

DR. GEO. W. TOPPING, DEWITT.

DR. WM. BRODIE, DETROIT.

S. P. DUFFIELD, DETROIT.

DR. J. E. BROWN, MONROE.

KATE LINDSAY, BATTLE CREEK,

To Report upon the Question of making this Society a

Delegated Body.

DR. FOSTER PRATT, KALAMAZOO.

DR. IRA D. BINGHAM, BRIGHTON. DR. W. PARMENTER, VERMONT VILLE.

H. B. BARNES, IONIA.

HAL. C. WYMAN, DETROIT.

To Visit and Report upon the Disease Prevailing at the
State Public School at Coldwater.

DR. J. H. BENNETT, COLDWATER.

DR. GEO. E. RANNEY, LANSING.

DR. E. S. DUNSTER, ANN ARBOR.