He stated that four

or five years ago lie was upon for stone by lateral lithotomy, but that soon symptoms of stone again appeared. On the 9th April lie was placed under chloroform, and the calculus was with some difficulty seized with the lithotrite.


However, all attempts

at crushing the stone it resisted all efforts. The unavailing, blades were felt to bite through part of the crust, but the remainder of the stone could not be broken. Considerable force was employed. Litholapaxy was then abandoned, as the calculus was supposed to be too hard to be crushed. But now a new complication appeared apparently the stone could not be dislodged from the blades of the lithotrite. The blades could This be made to open only a certain distance. was naturally supposed to be caused by the contact of the male portion against the neck of the bladder. Nor could they be closed, and it was imagined that this was due to the preAfter sence of the stone between the blades. many fruitless efforts to close the blades, it was decided that the only way out of the difficulty was to perform suprapubic lithotomy, and to remove the stone from the grasp of the instrument. This was accordingly done, the male blade being used as a guide. When the bladder was opened, no stone could be felt between the blades, but it was found to have fallen below their level and was lying close to the neck of It was removed by a lithotomy the bladder. forceps. As no cause could be discovered within the bladder, why the blades should not shut, the whole instrument was carefully examined, audit was found that at the upper extremity within the cylinder, the male blade had be-.come twisted 011 its horizontal axis, while at the same time it was somewhat bent forwards. This presented the opening and closing of the blades, nor could the defect be remedied. The shank of the lithotrite was then filed through a short distance away from the point of the penis, and the blades were removed through the abdominal wound. In spite of all this manipulation the periThe upper part of the toneum remained intact. wound was closed with sutures, while through the lower part a drainage tube was passed into the bladder. Stimulants, &c., were given to the patient, and the wound was dressed frequently. On the 10th his temperature was 100?, and he suffered from some pain in the vesical region. He was very weak, and was were

% JJliipi






D. M.


Civil Surgeon, Sialkote.



Mahomiriedan male,


u. b.,




On the lltli his weakness was greater, and in of careful nursing he died in the evening of pure asthenia.



Sialkote Civil Hospital on the April 1892, suffering from vesical calculus. was weak aud aiiremie, and his age was 55> into



7th He

The calculus weighed zv, and consisted of a uric acid nucleus and a pliosphatic crust. After removal.from the bladder it was easily crushed.




It was oval iii 6hape, and while in the bladder had been seized by its long axis. When crushed externally, it was seized by its short axis. Probably if it had been seized at first by its short axis, 110 difficulty would have been experienced. No post-mortem was allowed. There was 110 sign of peritonitis.



A Case of Litholapaxy with a Peculiar Complication.

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