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with numerous Vesical Calculi, BY THOMAS G, MORTON, M.D., Surgeon to the Pennsylvania Hospital. In the month of August, 1869, Mr. E. H. Wright, of Vincent- town, New Jersey, called upon me, requesting an examina- tion of his urethra, in the hope of some relief for a stricture, which had given him intense suffering for a number of years; stating that no amelioration of his trouble was experienced, although he had had long-continued medical treatment prior to his coming to the city. The patient was pale, haggard, and emaciated, and although but fifty years of age, looked much older. He informed me that his earliest symptom of urinary difficulty occurred when he was about nineteen years of age, and that when crossing a field, on attempting to urinate while walking, he experienced a sudden pain far back in the urethra and an im- mediate stoppage in the flow; retention during the succeeding thirty-six hours resulted, and after the use of warm fomenta- tions, the urine was again voided; at this time, as well as since, he has been aware of some urethral impediment. This did not, however, interfere with his marriage in early life, and several children resulted from the union. The urethral difficulty gradually increased, and pain became a constant and prominent symptom. A second marriage, some years later, yielded no issue,--the patient found that the semen was retained either in the bladder or urethra, and some time afterwards would dribble away with the urine. The pain during the past ten years had been intolerable, and has been increasingly so during the last year, which he de- scribed as worse than death. A constant desire to empty the bladder, with incontinence of urine, has existed for several years, and for more than a twelvemonth the flow of urine has been accompanied by blood, mucus, and pus in considerable quantity. During the past few years, in order to get relief from pain, he , had contracted the habit of opium-eating, and took a very large amount, never measuring his dose. On inquiry, I learned that an attempt had been made some five months ago to give relief by a dilatation of the urethra, and a catheter had been inserted every other day, which not only produced terrible agony, but yielded no abatement of his malady. From his long-continued suffering excessive emaciation re- sulted, and, as might well be supposed, his digestive organs and nervous system were in wretched condition. On passing a steel bougie, I found that after its introduction a short distance the urethra was blocked up by a mass of cal- culus, and no attempt was made to pass this obstruction. Examining the perineum, a long, hard tumor, apparently occupying the urethra, was found, and unquestionably was a continuation backwards of the calculus which I had found in the anterior urethra; a little further manipulation confirmed this, for this apparent long stone was made up of a number of stones, whose facets rubbed smoothly one upon the other, and allowed considerable motion and deviation in the urethra. It , may seem strange, but the patient was amazed when the state of the case was explained to him, for he had never known that he was a subject of calculous disease,-his belief was that only an organic stricture existed. An operation was readily agreed to, and on the 27th of August, in the presence of Drs. Wm. Hunt, Brinton, Packard, Longstreth, and Mears, I made an incision through the perineum, about two inches long, upon the stone, in the median line, and removed a large number of stones, all beautifully joined together; continuing the search towards the bladder, I found that it was necessary to slightly increase the original incision, when the urethra, as far back as the bladder, was found impacted with stones; the bladder had also a considerable number of calculi, varying in size from that of a pigeon-egg to that of a small pea. The urethra was so much dilated that no trouble was experienced in readily introducing the finger into the bladder. As dilatation had been so fully per- formed, little or no injury of the neck of the viscus was sustained in removing the larger stones. There was an attachment between the last urethral and the first bladder stone, or, perhaps more correctly, the bladder stone was impacted, and in removing its urethral continuation a fracture occurred, and a small frag- ment remained imbedded in the neck; several attempts failing to extract this, it was thought prudent to abandon the effort. The patient made a rapid recovery, and without a single bad symptom; in two days he voided the urine by the urethra, and on the tenth day he left for his home in New Jersey. On the 26th of September following he called, and reported himself as quite well in every respect, and that a small fragment of stone had since passed. In the month of July, 1870, I saw Mr. Wright: he was then in vigorous health, and his bladder and urethra were sound. Seventeen stones were taken from the urethra, weighing four hundred and forty grains, and five from the bladder, in all weighing two ounces and some grains: they were of the phos- phatic variety. The most anterior of the urethral stones meas- ured one and a half inches in length and two inches and a quarter in circumference; the total length of the joined urethral stones is three and one-fourth inches, and their greatest circum- ference two and a quarter inches; when placed in position, as may be seen in the photograph, the stones have the shape of the urethra. From the patient's history, it would appear that the stoppage of urine, from which he suffered thirty years before, was doubt- less due to the lodgment of a calculus, and that this continued to present a barrier to the escape of urine. The calculi, on forming, were driven as far as the original stone, being shapen to the parts, and, as they increased in size, accommodating themselves one upon the other, while the urethra gradually became dilated. The constant movement of the penis and perineum from muscular contraction and otherwise prevented their union, and produced the beautifully smooth and regular facets between the various calculi, so that when joined they