Patient objected to be examined without chloroform. He was ordered to have an ounce of castor-oil at 6 P. M. of 8th November and an enema of castor-oil and warm water at 8 a. m. of 9th November 1878. About 12 noon of 9th November 1878 he was examined, and I found that there was a sac in the urethra just in front of the scrotum in the median line. In this sac I felt a stony crackling. I could easily count them, and found that there were four calculi in this sac. I was informed that patient had been operated on before by a native surgeon who could only remove two small calculi from this same sac ; the operation was performed about 7 years ago, but the patient states that he was not relieved of the pain in the glans penis by this

operation.

I made my incision in the middle line into the most propoint of the sac in the urethra (I may state here that I was quite unable to pass the sound beyond about one and a half inches from the glans penis because of the passage being nearly obliterated by stones which I could easily touch). At the place of my incision I noticed that there was^ a very small tortuous fistula running through the sac into the urethra: urine very seldom dribbled through this fistula. Four small calculi were found in this sac. On endeavouring to pass my sound further on in the urethra, I could only do so for about two inches, and found again that it impinged upon a stone ; this stone was near the membranous portion. By a slight pressure from below upwards and quietly working with my index finger (left) and thumb, I found the stone moviug towards the urethral orifice. I gradually carried it into my incision and removed it with a dressing forceps. In the same manner I removed four more small stones which were lying in a line (like beads) in the patient's urethra. In short I may say that the urethra in this case was nearly as full of small calculi as a tasbih or mala is of beads. There were in all nine calculi in his urethra, the largest of them was about the size of a small almond, and the smallest about the size of a plum. When these stones were removed I endeavoured to pass the sound. I could easily do so, and found the urethra dilated to the size of that of an old man. After sounding the urinary bladder I found that there were three more calculi in it. Now I thought it advisable to perform lateral lithotomy. I cut in the usual On introducing the forceps I manner on the right side. caught hold of the largest stone, but on drawing out the forceps I found that the stone had slipped out of its grasp. Thinking that unfortunately the stone had broken in pieces, I introduced the scoop and brought out about eight small calculi with facets on them. I now concluded that these small calculi articulating with each other formed the large calculus, this fact being proved by the pre sence of facets. On my second trial with the scoop I brought out several small fragments proving that these united calculi were covered with a thin layer of stony deposit which was found to be phosphatic. Having introduced my finger into the bladder I found to four small calculi my surprise that there were still remaining, which were removed by the forceps. I washed the bladder with common fresh water and afterwards could remove very small fragments with the aid of a scoop. To my entire satisfaction I washed the bladder a second time without finding any more stones. There was no hemorrhage (proper) except the slight oozing of blood which takes place in a normal case of minent

CASE OF MULTIPLE VESICAL AND URETHRAL CALCULI. Reported

by

Assistant-Surgeon Beli

Ram,

Mianwali. Ali Mahomed, a Mahomedan male aged about 13 years, resident of Buri Khail in Mianwali division, cultivator by occupation, came to Mianwali dispensary on the 8th November 1878 complaining of a stone in his urethra and a stony feel in his bladder.

lithotomy. Weight.?The total weight of the stones and fragments was giij?3ij. The largest calculus weighed 3iss ; the smallest grs XL 3vij of chloroform were used, and the patient was about an hour on the operating table. The total number of stones removed was twenty-one. After treatment, 9 th November 1878.?Cold

water

March 1,

1879.]

A MIRROR OF HOSPITAL PRACTICE.

for the wound ; a grain of opium to be given hours after the operation. Pare milk and sugar as diet. The patient made a good recovery, and was removed from hospital on the 19th of November. The calculi were of uric acid. The fistula in front of the urethra closed while he was in hospital, and I ascertained afterwards that the perineal fistula healed and that the boy got perfectly well.

dressing two

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Case of Multiple Vesical and Urethral Calculi.

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