MEDICAL HISTORY OF SOME CASES OF VESICAL CALCULI OPERATED ON IN BIJNOR HOSPITAL IN 1890. By Supgeon G. H.
FINK,
i.m.s.
Case I.?Dhunno, at. 6 years, Hindu male child, was admitted into Bijnor Hospital for vesical calculus on the 14th March 1890. Previous History? 1. Duration two months. 2. Cause (?) Present State 1. Passes urine with difficulty; urine high coloured. 2. Suffers from prolapsus ani on micturition. 3. Constantly rubs glans penis with fin?
gers.
4. Calculus
present
on
sounding.
Treatment.?Castor-oil 3'i.i at ni^lit. Enema of soap and water in the morning. 15tli March 1890.?Lateral lithotomy under chloroform after sounding once again, when
calculus The
was
present.
straightforward and took Calculus oval in form ; yellow in colour ; flat surfaces Y x 1"; weight 30 grains composed of urates. After treatment.?The bladder was washed out with warm mercurial lotion, a T-bandage applied, and the knees and ankles tied with soft bandage. Barley water and milk and m. ii of tincture of hyoscyamus prescribed* operation
was
about 15 minutes.
$2
238
INDIAN MEDICAL GAZETTE.
.16th March 1890.?Temp. M. 102-4' F. E. 100'4? F. No pain in abdomen. The temperature remained high for a couple of* days longer, never rising higher than the above register, and on the 19th March it became normal; urine was passed through urethra on the 24th March, aud on 26th March the wound had perfectly healed, and there were no untoward symptoms of any sort, so the patient was discharged cured. Duration from date of admission to that of discharge 12 days. Case II.?Sibba, at. 35 years, Hindu male, was admitted into hospital on the 16th March 1890 for vesical calculus. Previous History? 1. Duration six years. 2. Cause (?) 3. Other points. About 2 years ago an abscess formed in the perineum, which was opened by a barber, which might account for a mark of incision and thickening of tissues in this re-
gion.
Present State? 1. Passes blood with urine, feels great difficulty in micturition, and there is frequency of micturition also No present which is increasing. blood in passing urine. 2. On passing the sound into the bladder, there was discovered a stricture at the mouth of the urethra; a smaller sized sound was then introduced, and it was discovered that there was more than one calculus, viz., one of smaller size in the membranous or prostatic portion and one of larger size in the bladder. It was considered advisable to push back the smaller calculus which was impacted in the urethra, and then to withdraw it by means of a large sized canula aud the evacuating apparatus. The meatus urinarius had to be incised to give passage to a catheter, but I did not succeed in evacuating the smaller stone. A No. 12 canula, the smallest we had in hospital, could .not be inserted, aud so the operation of lithotomy was undertaken on the 16th March 1890. If No. 18 canula could have been passed, the smaller calculus would probably have passed through its lumen and been evacuated. On the 16th March 1890, lateral lithotomy was performed; the operation lasted about 30 miuutes. 1. Number of calculi three (3). 2. Form (a) Dumb-bell shaped ; (b) like the semilunar bone of carpus; (c)
irregular. .Weight; (a)
340 grains; (b) 60 grains; (c) 30 grains, 4. Composition urates aud oxalates. N,B.?The perineum was deep owing to thick3.
ened tissues.
[Aug.
1891.
After treatment.?Morphia suppository in rectum. Poultice?ov.er pubes. Temp. E. 103-4? F. VIth March 1890.?Temp.: M. 104? F. E. 102-4? F. Pain in hypodastrio region; burning on micturition. m. x. R. Liq. Ext. of PichL Sodte Bicarb
gr.
Aqua
x.
5i. ter die.
18th March 1890.?Temp. M. 98? F. E. 101 ?F. Slight tenderness over pubes ; wound cleau; passes urine through wound. Continue mixture as before. 19th March 1890.?Temp. M. 98'4?F. E. 99 ?F. Wound clean, passes urine through wound. Continue mixture as before. 20th March 1890.?Temp. M. gg.^o-p ?
?
ii
well. Continue mixture. 24j?^ March 1890.?Temp, normal; passes urine through urethra; wound healing. Continue treatment. 26th March 1890.?Bowels constipated ; has slight fever. 100?F.
Doing
Pulv
R.
2nd
cured
3i. statim.
Jalapse
April 1890.?Quite 17 days in hospital.
;
well ;
discharged
Case IV.?Allah Bux, cet. 2b years, Musulmale child, was admitted into Bijuor Hospital on the 24th March 1890 with vesical ?
man
calculus.
Previous History?Doubtful. Present State? 1. Pain on micturition, child cries. 2. Blood in urine. 3. Rubs prepuce constantly. 4. Calculus present, on sounding. Treatment?Castor-oil 31 at night; enema the
following morning. 25th done.
March
1890.?Lateral
lithotomy
Operation straightforward.
operation
30 minutes.
Calculus oval; yellow in colour;
grains ;
After
urates. treatment.
out with
was
Duration of
weight
40
Bladder and wound washed mercurial lotion 1 in 4000. Tapplied, knees and ankles tied. Temp. ?
warm
bandage E. 101?F,;
no
pain.
This child's temperature varied between 99 and 100? F. up to the 11th April 1890, and tlie urine came through the wound notwithstanding washing out of bladder, diluent drinks, and quinine mixture. On the 12th April the child began to micturate through the urethra, the temperature went down to normal, and from that day everything went well with him, and he was discharged on the 17th April 1890, cured. Time in hospital 25 days. Case V.?Munya, at. 4 years, Hindu female child, was admitted into Bijnor Hospital on the 20th April 1890, with vesical calculus.
Acq. 1891.]
FINK'S CASE OF VESICAL CALCULUS.
Previous History? 1. Duration one year. 2. Cause (?) in micturition. Occasionally drops of blood iu urine. 3. Prolapsus ani on defecation. 4. Calculus on sounding.
Difficulty
Treatment.?Dilatation
of urethra
and
re-
moval of calculus with dressing forceps. Operation 7 minutes, calculus oval, .urates, 50 grains in weight. E. 102?F. Barley water. April 1890.?Temp. M. 100? F. E. 99? F. Passes high-coloured urine; there is no tender-
Temp.
21 st ness
of abdomen.
R
gr. ii
Sodas Bicarb
Aquse
...
...
...
5ii
ter die.
Continue
barley
water.
April 1890.?Temp, normal; urine clear ; Discharged cured. Time in passed freely. hospital 8 days. 28th
Case
male, 4th
50 years, mehter caste, admitted into Bijnor Hospital on the 1890, with vesical calculus.
VI.?Niadur, cat.
was
May
Previous History? 1. Duration four years. 2. Cause ^?) Present State? 1. Passes urine with difficulty. 2. Occasionally yiasses drops of blood after micturition. 3. Painful micturition with constant irritation of glans penis. 4. Prolapsus ani on defoecation. 5. Vesical calculus present on sounding. Treatment.?Enema of soap and water ; litholapaxy was done on the 4th May 1890; operation, was straightforward, duration 90 minutes, calculus oval; urates ; lithotrite introduced four times ; weight of calculus 630 grains.
After treatment.?Barley R
Tinct.
water ad lib. m. x.
Hyoscyami
Aquae ad
ter die.
5th May 1890-?Urine somewhat high-coloured ; passed a few pieces of calculus ; abdomen above pubes slightly tender on presure. Temp. M. and E. normal. Treatment? Continue. A large poultice to be applied over hypogastrium.
May 1890.?No tenderness; slight pain during micturition ; urine slightly coloured; no gravel passed. Temp. M. and E. normal; dis6th
till ue former treatment. R
Ext. Pichi
Aqueead.
liquid
...
239
7th May 1890.?No pain. Temp, normal. Continue treatment. 8th May 1890.?No pain; feels quite well
Present State? 1. 2.
?
...
...
ter die.
ra. x.
3i
Temp,
Continue treatment. 1890.?Discharged cured.
normal.
9th
May VII?Kesri, ait. 50 years, Hindu male, admitted into Bijnor Hospital on the 8th
Case was
June 1890, for vesical calculus. Previous History? 1. Duration two years. 2. Cause (?) Present State?1. Great difficulty in micturition. 2. Occasionally a few drops of blood with urine. 3. Prolapsus ani during defecation. 4. Calculus present on sounding. Treatment.?Soap and water enema. 8th June 1890.?Litholapaxy was performed under chloroform. The operation was straightforward and took 17 minutes; calculus oval, yellowish, 120 graius in weight; one introduction of lithotrite. After treatment.?Barley water ad libitum. R
Tinct. Hyo3cyami Sodte Bicarb. Aquse ad.
m. v. ...
gr. x.
...
ter die.
^i.
Temp. E. 99? F. 9th June 1890.?No pain in abdomen ; urine slightly coloured. Temp. M. 98'4?F. E. 99*2?F. \0th June 1890.?Temp. M. 98?F. E. 99?F. Slight pain in passing urine. 1 \th June 1890.?Temp, normal; no pain or tendernessover abdomen; urine normal in colour; no pain on micturition. Cured, discharged. Case F7i7.?Fallira, cet. 60 years, Mahomedan, was admitted into Bijnor Hospital on the 15th June 1890 for vesical calculus. Previous History? 1. Duration three years. 2. Cause (?) Present State? 1. Complains of pain during micturition. 2. Passes blood occasionally. 3. Heaviness in perineum. 4. Calculus present on soundinc. N.B.-?There is a suspicion of two calculi, one large and the other small. Treatment.?Enema of soap and water. was done under chloroform and the operatiou was straightforward; took 32 minutes; lithotrite introduced twice; weight of calculus 600 grains; composition urates. N.B.?Has cystitis. After treatment.?Bladder washed out with warm mercurial lotion. T-bandage applied.
Litholapaxy
Poultice applied B,
over
pubes.
Sodse Bicarbonatis Tr. Hyoscyami ... Aquse ad
...
...
gr.x. ni. v.
=i/ ter
die.
240
INDIAN MEDICAL GAZETTE.
Barley
water ad libitum. Temp. E. 99?F. 16*A June 1890.?Temp. M. 98?F. E. 99?P. No pain over pubes; slight pain on passing urine; passed a few pieces of gravel; urine slightly coloured. Continue treatment. 17th June 1890.?Urine slightly coloured ; passed a good deal of gravel. Continue treatment. 18M June 1890.?Urine slightly coloured; passed a little gravel. Continue treatment. 19*f/i June 1890.?Urine clear. Discharged cured. CaseIX.?Kadhera, at. 16 years, Hindu male, was admitted into Bijnor Hospital on the 16th June 1890, for calculus of the bladder. Previous History? 1. Duration two years. 2. Cause (?) Present State? 1. Difficulty in micturition. 2. Pain. 3. Frequency of micturition. 4 Passes blood occasionally. 5. Calculus detected on sounding. Treatment.?Enema of soap and water. Lateral lithotomy was done and three calculi extracted. (a) 189 grains, urates, kidney-shaped, I ? inches long, ^ inch broad ; (b) pea shaped, urates, 4 grains ; (c) pea-shaped, urates, 4 grains. Bladder washed out. After treatment.?Milk and barley water.
Morphia suppository per rectum. Evening Temp. 100'2?F. ; pulse quick tenderness 19*/i
fever. R.
over
;
no
abdomen.
June.?Slight coustipation
;
M. 99'2?F. E. 98. 4?F.
Diaphoretic
has
slight
mixture
Continue milk and
barley
ter die. water.
20^/d June.?Passed two motions. Temp. M. 98-4?F. E. 98?F. '23rd June.?Is costive ; wound healthy. R
01. Ricini 3i. stcitim.
Continue treatment.
24tliJune.-?Passed one motion. At 12-30 p.m. there was secondary haemorrhage and about th ree or four ounces of blood were lost. Assistant Surgeon Ranjit Singh Saring washed the wound and plugged it and ordered cold lotion; small pieces ot ice were also introduced into the rectum. 5-30 p.m. No bleeding, except slight moistening of bandage and a little dribbling through the urethra. 2nd July.?Passed urine through urethra. 12/A July.?Still doing well ; wound healing rapidly ; passes urine through urethra. 15th July.?Discharged cured. Case X.?Faiyaz, cet. 56 years, Mahomedan male child, was admitted into Bijnor Hospital for vesical calculus on the 24th June 1890. Previous History? 1. D uration two years. 2. Cause (?)
[Aug.
1891.
Present Condition? 1. Occasional stoppage of uriue during micturition. 2. Pain during passing uriue. 3. PiTssed blood with urine occasionally. 4. Calculus detected by sound. Treatment.? Lateral lithotomy was performed under chloroform. The operation was straightforward and two stones were extracted, (a) and (b) urates 60 and 40 grains respectively; oval in form, and of yellowish colour, (a f X ? inch; (b) | x | inch. Temp, at 6 p.m. 100?F.
After
R
treatment?
Tinct.
Barley
opii
m.
ad water ad libitum.
Aquse
...
iii.
3iv
...
...
ter die.
June.?Temp. M. pain ; no bleeding. 26t/i June.?Temp. 98?F.
99?F. E. 99?F.
%5th
No
Wound healing. 29th June.?Passed urine through urethra; doing well. 4:th July.?Discharged cured. Case XT.?Guliimi, est. 60 years, Mahomedun male, was admitted into Bijnor Hospital on the 28th June 1890 with vesical calculus. Previous History? 1. Duration twelve years, probably. 2 Cause (?) Present State? Stream 1. Passes urine with difficulty. not altered in size. Flow of urine is checked temporarily and then continues. 2. Occasionally passes blood with urine. 3. Retention of urine occasionally. 4. Walks with difficulty and feelB a heaviness in the perineum. 5. Calculus detected by sound.
Treatment.?Litholapaxy
performed
was
un-
der chloroform and was straightforward. Stone composed ot urates and phosphates. Time 100 minutes ; weight of calculus 2,100 grains. Number of introductions of lithotrite 5. N.B.?The patient has chronic cystiivs. R
Sodte Bicarb. Tinct. Hyoscyami
...
Aquse
...
...
gr. x. m. x.
51.
...
ter die.
Poultice over hypogastric region. libitum. Temp, at 6 p.m. 102?F.
Barley
water ad
29th June.?Temp. lU. 99?F. E. 99?F. No tenderness over pubes; urine somewhat high colour; feels pain on passing urine ; passed a few pieces of gravel ; (about 20 grains). Treatment continued. 30th June.?Temp. M. 98* 4?F. E. 98eF. Urine slightly coloured ; passed a few pieces of
gravel (about
10
grains).
Treatment continued. Is/
July.?Urine
is
clear;
ness.
Treatment continued.
uo
pain
or
tender-
Aug.
FINK'S CASE OF VESICAL CALCULUS.
1891.] 2nd
tenderness or pain ; urine normal; bladder examined by sound; no calculus or pieces of stone detected. Discharged cured. Case XII.?Karim Bux, est. 18 years, Mahomcdan male, was admitted into Bijuor Hospital on the 26th August 1890 for vesical calculus. Previous History? 1. Duration two years* 2. Cause (?) Present State? 1. Pain on micturition.
July.?No
2. Blood with urine occasionally. 3. Frequency of micturition. 4. No alteration in size of stream. 5. Stone detected by sound. Treatment.?The calculus was removed on the 30th August by lateral lithotomy under chloroform. The operation was straightforward. After treatment.?Barley water ad libitum. Tinct.
Hyoscyami.
mm. x.
Temp. 101?F. 7th September.?Temp. M, 101'2?F. E. 102?F. 6 p.m.
R
Antifebrin gr.
x
statim.
Continue other 8tli
September.?Temp. Antifebrin
...
treatment.
M. 102?F. E.
...
...
Continue medicines and 9th
September.?Temp.
R
10th Ii
barley
100?F. gr. x.
...
water.
M. 98?F. E. 98?F.
Quinine Continue other treatment. ...
...
gr.
v.
September.?Constipation present. Castor-oil 5i. statim. Temp, normal.
barley water and tinct. hyoscyami. September.? Wound healed. Passes urine through urethra. 19th September.?Passes urine through ureContinue llf/i
thra.
Continue treatment. cured. Remarks.?It will be observed that out of the twelve cases above described, and which I operated on in the Bijuor Hospital, there were three (Case II, IX and X) that had more than one calculus present, thus showing that it is more frequent than one imagines. Moreover, it is more easy to prove multiple calculi in the operation for lateral lithotomy than in the modern operation of litholapaxy, since there are the stones before you whole from their impacted situations ; but in the latter case you have a mass of debris only, which might be that of half-a-dozen calculi, for all 21 st.
September.?Discharged
you know! Case II was a man aged 35 years, who had had an operation performed by a barber some time previous for what I understood him to describe as an abscess of the perineum. But oil sounding him, no sooner the sound arrived at about the prostatic or membranous portion
,
241
of the urethra, and just about beneath' the situation of the scar in the perineum, I discovered a sharp grating sensation against the sound like that of a rough calculus. The sound on passing this emerged into the bladder and discovered a second calculus, which elicited a click. On extracting the sound, it again rubbed against the supposed calculus in the situation above mentioned. The diagnosis was two calculi (one i') the urethra, the other in the bladder). I endeavoured to push back the Tried to the urethral calculus, but failed. evacuate it by means of a No. 12 canula and failed. No larger sized canula could be Hence even after incising the urethra. passed I performed lateral lithotomy, and discovered that instead of two calculi there were three. Two were impacted in the prostatic membranous portion of the urethra and were facetted, and the third was in the bladder. Case IX was in a lad of 16 years on whom I had to perform lateral lithotomy from want of suitable sized instruments for litholapaxy. In this case the calculi were easily extracted, two being minute. Case X.?There were two calculi, which were extracted easily by lateral lithotomy. The above three cases have made me exceedingly cautious both in sounding for calculus of the bladder, and rn exploring the bladder carefully with the finger after the operation of lithotomy, and with Thompson's souud after litholapaxy, for I am convinced that multiple vesical calculi are more common than we imagine; otherwise the three cases in the twelve 1 have just described must be a very strange coincidence.
FINK,
i.m.s.
Case I.?Dhunno, at. 6 years, Hindu male child, was admitted into Bijnor Hospital for vesical calculus on the 14th March 1890. Previous History? 1. Duration two months. 2. Cause (?) Present State 1. Passes urine with difficulty; urine high coloured. 2. Suffers from prolapsus ani on micturition. 3. Constantly rubs glans penis with fin?
gers.
4. Calculus
present
on
sounding.
Treatment.?Castor-oil 3'i.i at ni^lit. Enema of soap and water in the morning. 15tli March 1890.?Lateral lithotomy under chloroform after sounding once again, when
calculus The
was
present.
straightforward and took Calculus oval in form ; yellow in colour ; flat surfaces Y x 1"; weight 30 grains composed of urates. After treatment.?The bladder was washed out with warm mercurial lotion, a T-bandage applied, and the knees and ankles tied with soft bandage. Barley water and milk and m. ii of tincture of hyoscyamus prescribed* operation
was
about 15 minutes.
$2
238
INDIAN MEDICAL GAZETTE.
.16th March 1890.?Temp. M. 102-4' F. E. 100'4? F. No pain in abdomen. The temperature remained high for a couple of* days longer, never rising higher than the above register, and on the 19th March it became normal; urine was passed through urethra on the 24th March, aud on 26th March the wound had perfectly healed, and there were no untoward symptoms of any sort, so the patient was discharged cured. Duration from date of admission to that of discharge 12 days. Case II.?Sibba, at. 35 years, Hindu male, was admitted into hospital on the 16th March 1890 for vesical calculus. Previous History? 1. Duration six years. 2. Cause (?) 3. Other points. About 2 years ago an abscess formed in the perineum, which was opened by a barber, which might account for a mark of incision and thickening of tissues in this re-
gion.
Present State? 1. Passes blood with urine, feels great difficulty in micturition, and there is frequency of micturition also No present which is increasing. blood in passing urine. 2. On passing the sound into the bladder, there was discovered a stricture at the mouth of the urethra; a smaller sized sound was then introduced, and it was discovered that there was more than one calculus, viz., one of smaller size in the membranous or prostatic portion and one of larger size in the bladder. It was considered advisable to push back the smaller calculus which was impacted in the urethra, and then to withdraw it by means of a large sized canula aud the evacuating apparatus. The meatus urinarius had to be incised to give passage to a catheter, but I did not succeed in evacuating the smaller stone. A No. 12 canula, the smallest we had in hospital, could .not be inserted, aud so the operation of lithotomy was undertaken on the 16th March 1890. If No. 18 canula could have been passed, the smaller calculus would probably have passed through its lumen and been evacuated. On the 16th March 1890, lateral lithotomy was performed; the operation lasted about 30 miuutes. 1. Number of calculi three (3). 2. Form (a) Dumb-bell shaped ; (b) like the semilunar bone of carpus; (c)
irregular. .Weight; (a)
340 grains; (b) 60 grains; (c) 30 grains, 4. Composition urates aud oxalates. N,B.?The perineum was deep owing to thick3.
ened tissues.
[Aug.
1891.
After treatment.?Morphia suppository in rectum. Poultice?ov.er pubes. Temp. E. 103-4? F. VIth March 1890.?Temp.: M. 104? F. E. 102-4? F. Pain in hypodastrio region; burning on micturition. m. x. R. Liq. Ext. of PichL Sodte Bicarb
gr.
Aqua
x.
5i. ter die.
18th March 1890.?Temp. M. 98? F. E. 101 ?F. Slight tenderness over pubes ; wound cleau; passes urine through wound. Continue mixture as before. 19th March 1890.?Temp. M. 98'4?F. E. 99 ?F. Wound clean, passes urine through wound. Continue mixture as before. 20th March 1890.?Temp. M. gg.^o-p ?
?
ii
well. Continue mixture. 24j?^ March 1890.?Temp, normal; passes urine through urethra; wound healing. Continue treatment. 26th March 1890.?Bowels constipated ; has slight fever. 100?F.
Doing
Pulv
R.
2nd
cured
3i. statim.
Jalapse
April 1890.?Quite 17 days in hospital.
;
well ;
discharged
Case IV.?Allah Bux, cet. 2b years, Musulmale child, was admitted into Bijuor Hospital on the 24th March 1890 with vesical ?
man
calculus.
Previous History?Doubtful. Present State? 1. Pain on micturition, child cries. 2. Blood in urine. 3. Rubs prepuce constantly. 4. Calculus present, on sounding. Treatment?Castor-oil 31 at night; enema the
following morning. 25th done.
March
1890.?Lateral
lithotomy
Operation straightforward.
operation
30 minutes.
Calculus oval; yellow in colour;
grains ;
After
urates. treatment.
out with
was
Duration of
weight
40
Bladder and wound washed mercurial lotion 1 in 4000. Tapplied, knees and ankles tied. Temp. ?
warm
bandage E. 101?F,;
no
pain.
This child's temperature varied between 99 and 100? F. up to the 11th April 1890, and tlie urine came through the wound notwithstanding washing out of bladder, diluent drinks, and quinine mixture. On the 12th April the child began to micturate through the urethra, the temperature went down to normal, and from that day everything went well with him, and he was discharged on the 17th April 1890, cured. Time in hospital 25 days. Case V.?Munya, at. 4 years, Hindu female child, was admitted into Bijnor Hospital on the 20th April 1890, with vesical calculus.
Acq. 1891.]
FINK'S CASE OF VESICAL CALCULUS.
Previous History? 1. Duration one year. 2. Cause (?) in micturition. Occasionally drops of blood iu urine. 3. Prolapsus ani on defecation. 4. Calculus on sounding.
Difficulty
Treatment.?Dilatation
of urethra
and
re-
moval of calculus with dressing forceps. Operation 7 minutes, calculus oval, .urates, 50 grains in weight. E. 102?F. Barley water. April 1890.?Temp. M. 100? F. E. 99? F. Passes high-coloured urine; there is no tender-
Temp.
21 st ness
of abdomen.
R
gr. ii
Sodas Bicarb
Aquse
...
...
...
5ii
ter die.
Continue
barley
water.
April 1890.?Temp, normal; urine clear ; Discharged cured. Time in passed freely. hospital 8 days. 28th
Case
male, 4th
50 years, mehter caste, admitted into Bijnor Hospital on the 1890, with vesical calculus.
VI.?Niadur, cat.
was
May
Previous History? 1. Duration four years. 2. Cause ^?) Present State? 1. Passes urine with difficulty. 2. Occasionally yiasses drops of blood after micturition. 3. Painful micturition with constant irritation of glans penis. 4. Prolapsus ani on defoecation. 5. Vesical calculus present on sounding. Treatment.?Enema of soap and water ; litholapaxy was done on the 4th May 1890; operation, was straightforward, duration 90 minutes, calculus oval; urates ; lithotrite introduced four times ; weight of calculus 630 grains.
After treatment.?Barley R
Tinct.
water ad lib. m. x.
Hyoscyami
Aquae ad
ter die.
5th May 1890-?Urine somewhat high-coloured ; passed a few pieces of calculus ; abdomen above pubes slightly tender on presure. Temp. M. and E. normal. Treatment? Continue. A large poultice to be applied over hypogastrium.
May 1890.?No tenderness; slight pain during micturition ; urine slightly coloured; no gravel passed. Temp. M. and E. normal; dis6th
till ue former treatment. R
Ext. Pichi
Aqueead.
liquid
...
239
7th May 1890.?No pain. Temp, normal. Continue treatment. 8th May 1890.?No pain; feels quite well
Present State? 1. 2.
?
...
...
ter die.
ra. x.
3i
Temp,
Continue treatment. 1890.?Discharged cured.
normal.
9th
May VII?Kesri, ait. 50 years, Hindu male, admitted into Bijnor Hospital on the 8th
Case was
June 1890, for vesical calculus. Previous History? 1. Duration two years. 2. Cause (?) Present State?1. Great difficulty in micturition. 2. Occasionally a few drops of blood with urine. 3. Prolapsus ani during defecation. 4. Calculus present on sounding. Treatment.?Soap and water enema. 8th June 1890.?Litholapaxy was performed under chloroform. The operation was straightforward and took 17 minutes; calculus oval, yellowish, 120 graius in weight; one introduction of lithotrite. After treatment.?Barley water ad libitum. R
Tinct. Hyo3cyami Sodte Bicarb. Aquse ad.
m. v. ...
gr. x.
...
ter die.
^i.
Temp. E. 99? F. 9th June 1890.?No pain in abdomen ; urine slightly coloured. Temp. M. 98'4?F. E. 99*2?F. \0th June 1890.?Temp. M. 98?F. E. 99?F. Slight pain in passing urine. 1 \th June 1890.?Temp, normal; no pain or tendernessover abdomen; urine normal in colour; no pain on micturition. Cured, discharged. Case F7i7.?Fallira, cet. 60 years, Mahomedan, was admitted into Bijnor Hospital on the 15th June 1890 for vesical calculus. Previous History? 1. Duration three years. 2. Cause (?) Present State? 1. Complains of pain during micturition. 2. Passes blood occasionally. 3. Heaviness in perineum. 4. Calculus present on soundinc. N.B.-?There is a suspicion of two calculi, one large and the other small. Treatment.?Enema of soap and water. was done under chloroform and the operatiou was straightforward; took 32 minutes; lithotrite introduced twice; weight of calculus 600 grains; composition urates. N.B.?Has cystitis. After treatment.?Bladder washed out with warm mercurial lotion. T-bandage applied.
Litholapaxy
Poultice applied B,
over
pubes.
Sodse Bicarbonatis Tr. Hyoscyami ... Aquse ad
...
...
gr.x. ni. v.
=i/ ter
die.
240
INDIAN MEDICAL GAZETTE.
Barley
water ad libitum. Temp. E. 99?F. 16*A June 1890.?Temp. M. 98?F. E. 99?P. No pain over pubes; slight pain on passing urine; passed a few pieces of gravel; urine slightly coloured. Continue treatment. 17th June 1890.?Urine slightly coloured ; passed a good deal of gravel. Continue treatment. 18M June 1890.?Urine slightly coloured; passed a little gravel. Continue treatment. 19*f/i June 1890.?Urine clear. Discharged cured. CaseIX.?Kadhera, at. 16 years, Hindu male, was admitted into Bijnor Hospital on the 16th June 1890, for calculus of the bladder. Previous History? 1. Duration two years. 2. Cause (?) Present State? 1. Difficulty in micturition. 2. Pain. 3. Frequency of micturition. 4 Passes blood occasionally. 5. Calculus detected on sounding. Treatment.?Enema of soap and water. Lateral lithotomy was done and three calculi extracted. (a) 189 grains, urates, kidney-shaped, I ? inches long, ^ inch broad ; (b) pea shaped, urates, 4 grains ; (c) pea-shaped, urates, 4 grains. Bladder washed out. After treatment.?Milk and barley water.
Morphia suppository per rectum. Evening Temp. 100'2?F. ; pulse quick tenderness 19*/i
fever. R.
over
;
no
abdomen.
June.?Slight coustipation
;
M. 99'2?F. E. 98. 4?F.
Diaphoretic
has
slight
mixture
Continue milk and
barley
ter die. water.
20^/d June.?Passed two motions. Temp. M. 98-4?F. E. 98?F. '23rd June.?Is costive ; wound healthy. R
01. Ricini 3i. stcitim.
Continue treatment.
24tliJune.-?Passed one motion. At 12-30 p.m. there was secondary haemorrhage and about th ree or four ounces of blood were lost. Assistant Surgeon Ranjit Singh Saring washed the wound and plugged it and ordered cold lotion; small pieces ot ice were also introduced into the rectum. 5-30 p.m. No bleeding, except slight moistening of bandage and a little dribbling through the urethra. 2nd July.?Passed urine through urethra. 12/A July.?Still doing well ; wound healing rapidly ; passes urine through urethra. 15th July.?Discharged cured. Case X.?Faiyaz, cet. 56 years, Mahomedan male child, was admitted into Bijnor Hospital for vesical calculus on the 24th June 1890. Previous History? 1. D uration two years. 2. Cause (?)
[Aug.
1891.
Present Condition? 1. Occasional stoppage of uriue during micturition. 2. Pain during passing uriue. 3. PiTssed blood with urine occasionally. 4. Calculus detected by sound. Treatment.? Lateral lithotomy was performed under chloroform. The operation was straightforward and two stones were extracted, (a) and (b) urates 60 and 40 grains respectively; oval in form, and of yellowish colour, (a f X ? inch; (b) | x | inch. Temp, at 6 p.m. 100?F.
After
R
treatment?
Tinct.
Barley
opii
m.
ad water ad libitum.
Aquse
...
iii.
3iv
...
...
ter die.
June.?Temp. M. pain ; no bleeding. 26t/i June.?Temp. 98?F.
99?F. E. 99?F.
%5th
No
Wound healing. 29th June.?Passed urine through urethra; doing well. 4:th July.?Discharged cured. Case XT.?Guliimi, est. 60 years, Mahomedun male, was admitted into Bijnor Hospital on the 28th June 1890 with vesical calculus. Previous History? 1. Duration twelve years, probably. 2 Cause (?) Present State? Stream 1. Passes urine with difficulty. not altered in size. Flow of urine is checked temporarily and then continues. 2. Occasionally passes blood with urine. 3. Retention of urine occasionally. 4. Walks with difficulty and feelB a heaviness in the perineum. 5. Calculus detected by sound.
Treatment.?Litholapaxy
performed
was
un-
der chloroform and was straightforward. Stone composed ot urates and phosphates. Time 100 minutes ; weight of calculus 2,100 grains. Number of introductions of lithotrite 5. N.B.?The patient has chronic cystiivs. R
Sodte Bicarb. Tinct. Hyoscyami
...
Aquse
...
...
gr. x. m. x.
51.
...
ter die.
Poultice over hypogastric region. libitum. Temp, at 6 p.m. 102?F.
Barley
water ad
29th June.?Temp. lU. 99?F. E. 99?F. No tenderness over pubes; urine somewhat high colour; feels pain on passing urine ; passed a few pieces of gravel ; (about 20 grains). Treatment continued. 30th June.?Temp. M. 98* 4?F. E. 98eF. Urine slightly coloured ; passed a few pieces of
gravel (about
10
grains).
Treatment continued. Is/
July.?Urine
is
clear;
ness.
Treatment continued.
uo
pain
or
tender-
Aug.
FINK'S CASE OF VESICAL CALCULUS.
1891.] 2nd
tenderness or pain ; urine normal; bladder examined by sound; no calculus or pieces of stone detected. Discharged cured. Case XII.?Karim Bux, est. 18 years, Mahomcdan male, was admitted into Bijuor Hospital on the 26th August 1890 for vesical calculus. Previous History? 1. Duration two years* 2. Cause (?) Present State? 1. Pain on micturition.
July.?No
2. Blood with urine occasionally. 3. Frequency of micturition. 4. No alteration in size of stream. 5. Stone detected by sound. Treatment.?The calculus was removed on the 30th August by lateral lithotomy under chloroform. The operation was straightforward. After treatment.?Barley water ad libitum. Tinct.
Hyoscyami.
mm. x.
Temp. 101?F. 7th September.?Temp. M, 101'2?F. E. 102?F. 6 p.m.
R
Antifebrin gr.
x
statim.
Continue other 8tli
September.?Temp. Antifebrin
...
treatment.
M. 102?F. E.
...
...
Continue medicines and 9th
September.?Temp.
R
10th Ii
barley
100?F. gr. x.
...
water.
M. 98?F. E. 98?F.
Quinine Continue other treatment. ...
...
gr.
v.
September.?Constipation present. Castor-oil 5i. statim. Temp, normal.
barley water and tinct. hyoscyami. September.? Wound healed. Passes urine through urethra. 19th September.?Passes urine through ureContinue llf/i
thra.
Continue treatment. cured. Remarks.?It will be observed that out of the twelve cases above described, and which I operated on in the Bijuor Hospital, there were three (Case II, IX and X) that had more than one calculus present, thus showing that it is more frequent than one imagines. Moreover, it is more easy to prove multiple calculi in the operation for lateral lithotomy than in the modern operation of litholapaxy, since there are the stones before you whole from their impacted situations ; but in the latter case you have a mass of debris only, which might be that of half-a-dozen calculi, for all 21 st.
September.?Discharged
you know! Case II was a man aged 35 years, who had had an operation performed by a barber some time previous for what I understood him to describe as an abscess of the perineum. But oil sounding him, no sooner the sound arrived at about the prostatic or membranous portion
,
241
of the urethra, and just about beneath' the situation of the scar in the perineum, I discovered a sharp grating sensation against the sound like that of a rough calculus. The sound on passing this emerged into the bladder and discovered a second calculus, which elicited a click. On extracting the sound, it again rubbed against the supposed calculus in the situation above mentioned. The diagnosis was two calculi (one i') the urethra, the other in the bladder). I endeavoured to push back the Tried to the urethral calculus, but failed. evacuate it by means of a No. 12 canula and failed. No larger sized canula could be Hence even after incising the urethra. passed I performed lateral lithotomy, and discovered that instead of two calculi there were three. Two were impacted in the prostatic membranous portion of the urethra and were facetted, and the third was in the bladder. Case IX was in a lad of 16 years on whom I had to perform lateral lithotomy from want of suitable sized instruments for litholapaxy. In this case the calculi were easily extracted, two being minute. Case X.?There were two calculi, which were extracted easily by lateral lithotomy. The above three cases have made me exceedingly cautious both in sounding for calculus of the bladder, and rn exploring the bladder carefully with the finger after the operation of lithotomy, and with Thompson's souud after litholapaxy, for I am convinced that multiple vesical calculi are more common than we imagine; otherwise the three cases in the twelve 1 have just described must be a very strange coincidence.
