JAMA. 1932;99(6):490. doi:10.1001/jama.1932.02740580058023.
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Nephrolithiasis  Dr. R. Josetti recently reported before the Academia Nacional de Medicina of Rio de Janeiro a case of silent giant calculus of the kidney. He took occasion to discuss the indications and contraindications for operation in renal calculi, dividing the entire group of calculi of the kidney into four subgroups. The first subgroup comprises the type of silent benign calculi, which occurs frequently. Operation in cases of this type is not indicated since the patients do not suffer in any way and the presence of calculi is found only through roentgenologic examination. The second subgroup comprises calculi which produce such grave symptoms as colic, hematuria or pyuria and sometimes even endanger the life of the patient, from complications, such as acute anuria or generalized septicemia originating in the infectious pyelitic focus. In this type operation is always indicated. The third subgroup is represented by certain cases in which, in


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