FOUR CASES OF STON E?LITHOTOMY? RECOVERY.

(Under

care

of W. D. Stewaet Civil

Fbom Notes

by

Surgeon, CuttacJc).

Assistant Surgeon Baney Madhub Tagobe.

Urjoon, aged 6 years, native of Dhenkanal, caste Keut, was admitted into the Dhenkanal dispensary on 21st October 1876.

Was previously admitted for stone in bladder on 4th July last, with usual symptoms of stoppage of urine during micturition, dribbling, constant desire to void urine, and pain in doing so, great irritability of bladder and penis, which the child always rubs and pinches with his hands, prepuce thick and swollen, prolapsus ani from great straining, due to vesical irritation. Operation was not performed in July, as instruments were not at hand. On introducing the sound, after some time and trouble the stone was felt. The boy was put under chloroform ; as irritability and restlessness were great, urine escaped on the introduction of the sound, a slight click from the stone was then perceived, but could not be again obtained, as the calculus had got hooked up and closed in, as it were, in the folds of the bladder. We were very nearly giving up the search in despair, but the ether stone symptoms were, however, so marked that it was almost certain that the stone was present, but till we could feel it distinctly by the sound, we did not wish to operate; by careful sounding we at last found it. Lateral operation was performed, and the bladder reached. On introducing the finger, the same difficulty agniu presented itself, for the stone could not be felt ; it was high up, concealed and enveloped in the folds of the bladder, but was brought down with the scoop, and removed by forceps. Tiie boy progressed very favourably ; a week after the operation the greater part of the urine was passed by urethra. Wound has half closed, and is granulating rapidly. It was a size of a marble, and little

rough mulberry calculus, weighing 2 drachms. Case II.?Byragee, aged 5, native of Dhenkanal, caste Jhura, It was a case of was admitted as out-patient on 16th July last. stone, as proved by sound and other symptoms. Was admitted as an in-patient on 22nd October. General

health very weak ; he was feverish on admission. An enema of castor oil was administered, and after it had acted, the patient was

brought fully under the influence of chloroform, and the operation performed, when a mulberry calculus, weigh-

lateral

95

THE INDIAN MEDICAL GAZETTE.

3 drachms, was removed. There was great straining several times during the operation, causing prolapsus ani. Case progressed favourably. Quinine was given to check fever. Milk diet. Eight days after, Hie wound was granulating freely, and about half the quantify of urine passing naturally. Case III.?Gunputty, aged 12. Brahmin, native of Dhenkanal, said to have had stone for the last 8 years, presented himself at the dispensary on 30th October, with the usunl symptoms. Pain and difficulty in voiding urine are so great that he is obliged to press his heel against the perineum in order to get relief. On sounding, the stone was easily perceived, and as having a granular surface, and by introducing the finger into the anus, it was also distinctly felt. A dose of castor oil was given on the evening of admission, and the lateral operation performed next morning. The stone weighed 6? drachms, and had rough uric acid deposits on a phosphsitic surface. Case progressed favourably ; there was no fever ; 10 drops of tincture opium were given the night of the operation. Patient recovered, without a bad symptom.

ing

Fkom Notes by Assistant Surgeon Chooney Lalt. Dass. Case IV.?Benudee Sayee, caste Chasa, aged 35, was admitted into the Cuttack General Hospital on 26th September 1876 from Killa Durpun, with symptoms of stone in bladder, urine passed by drops,, said to be of 8 years' duration; occasional retention, frequent micturition, discharge of blood by After walking, he felt pain in the glands, penis, and urethra. irritation at prepuce ; bowels costive, straining at stool, and prolapsus ani ; body was very much emaciated, and the countenance was pinched from the prolonged suffering. Stone was easily detected by the sound. Rest, good food, and tonics were

prescribed.

On 10th the patient

October, a dose of castor oil was given. On 11th being fully chloroformed, the lateral operation for lithotomy was performed ; a straight staff was used, and the bladder reached without difficulty ; two stones were felt, the smaller of the two was removed easily, but the second was so large and round as scarcely to be seized by the forceps which The wounds had to be enlarged, both was at our disposal.

outwards and inwards in order to afford a passage for the unusual size of the stone, which was at last seized, and after much patience and trial removed without any untoward event

taking place.

weighed 5 drachms and was of the size of a egg, th? larger was round like a potato and weighed 6 oz.; both were phosphatic, and measured inches 1 '75 x 1'25 x 6, and 3 x 2'5 x 2 respectively. Milk diet. Vespere.?No bleeding ; urine mixed witli blood ,? free by woun

Four Cases of Stone: Lithotomy: Recovery.

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