and the stones
very large. The 4th case litholapaxy, but owing to the stricture lithotomy was performed in preference. The 5th case was almost hopeless from the very severe cystitis the boy was suffering from was
were
well suited for
when admitted. Case
1.?Chokha, a Hindoo male, aged 30, was suffering from symptoms of stone for two years. The urethral canal was capacious. The stone was easily caught by the lithotrite ; it was crushed and the fragments removed by the aid of The stone was a hard one and an aspirator. also large ; the debris weighed 6 drams : the operation lasted about
20
minutes.
The
man was
30th January, 1882, and was disthe 15th February. He had a charged little fever and cystitis after the operation, which passed off rapidly by the use of quinine admitted
on
the
cured
on
and tincture of steel. Case 2.?Sibba, a Hindoo male, aged 60, admitted on the 22nd March. He was suf-
LITHOLAPAXY. By
Surgeon-Major
R. C.
was
Sanders,
m.d.,
F.R.C.S.,
Surgeon, Barcilly. The following cases of Litholapaxy were treated in the Bareilly Dispensary during the year 1882 ; all the cases did well with the exception .of the 5th, in which case a rather tight stricture existed; this was dilated, but unfortunately the got extravasation of urine
and consecutive
which ended fatally. 9th and 10th were operated on by Surgeon P. J. Freyer, M.D. The difficulty experienced was to keep the patients long enough in the dispensary ; but in
pyaemia
Cases
all my
cases
the bladder
days
after the
ment
was
There of
was
operation
washed out
to make
sure no
some
frag-
left in it.
were
during
the .year
treated in the
1882, 52
cases
Bareilly Dispensary. lithotomy history of the fatal cases is given for the sake of comparison with the lithotrity cases ; the mortality during 1882 was exceptionally high. The first case of death took place suddenly on the 8th day after the operation; the cause of death could not be ascertained. The 2nd and 3rd when admitted, cases were in very had health A short
from the symptoms of stone for 15 months. was very painful ; the urine was
The micturition
Civil
man
fering
mixed with
elongated. trite
the prepuce abnormally The stone was crushed by the lithomucus
;
the very day he
on
was
taken in ; the stone
phosphatic calculus, and was crushed with the greatest case ; the fragments weighed 3 The drams ; the operation lasted 20 minutes. man took a large quantity of chloroform, about were noticed 13 drams. The following symptoms No on the day succeedingthat of the operation. fever ; no pain in the abdomen ; very slight pain in the penis ; urine passed copiously. Without any untoward symptoms he came round rapidly,
was
a
and
was
discharged
cured
on
the 28th March,
days after the operation. He left the dispensary and went home on foot. Case 3.?Bhola, a Hindoo male, aged 26, was admitted into the dispensary on 25th March with
seven
all the symptoms of stone, which had been greatly troubling him for a year. The stone was
easily caught an
was
and
man was
by
the lithotrite ; it
The debris
weighed operation lasted for 15 minutes. stopped in the dispensary for 4 days, then discharged cured on the 29th
drams. The
and crushed
uric acid calculus. The
March, 1883.] March.
He had no fever, no cystitis, nor anyother unfavorable symptoms of the operation. Caje 4.?Ramdeen, a Hindoo male, aged 55, was
admitted
April,
1882.
into the dispensary He
toms of stone for
crushed
by
suffering
was
four
years.
the lithotrite ; it
the
on
17th
from the sympThe stone was
was a
big
uric acid
calculus ; the fragments weighed 1 }4 ounces. The operation lasted 25 minutes. To crush the fragments, the instruments had in this case to be introduced into the bladder 7 times ; after each crushing the bladder was washed by an aspira-
April, i. e., on the 6th day after passed some small fragments operation, the 23rd April, on examining the urine. On with his bladder by a sound, a fragment was detected, which was immediately crushed ; it weighed The man had slight cystitis, which 20 grains. He was cured by the use of tincture of steel. was discharged on the 29th April, 1882. Case 5.?Nethram, a Hindoo male, aged 455 was admitted on the 27th April with all the tor.
On the 22nd he
the
symptoms of stone. The man had an urethral stricture, so there was at first much difficulty in the
passing lithotrite
lithotrite.
stricture
terism the
went on
broken and then the The stone
easily.
cathe-
forcible
By
was
easily large sized uric calculus ; the fragments acid weighed one The operation lasted for 30 minutes. ounce. There was rather free bleeding from the urethra in consequence of the structure being ruptured. The man got high fever after the operation, It
and crushed.
caught
was
the prepuce and scrotum
were
the infiltrated tissues all
tually got diarrhoea, 15th May. Case 6.?Summoo, on
the
and
a
was
a
symptoms of extravasation of urine
admitted
much swelled and He
sloughed. sank under
Mahomedan
9th May,
found,
were
1882.
He
it
evenon
male, was
the
was
labour-
ing under symptoms of stone for a year. The stone was easily crushed and the debris removed by aspiration. minutes. The
The
The stone
rapidly,
lasted about 15 uric acid calculus.
operation was an
fragments weighed
out any
about
one
dram.
unfavourable symptoms he and
69
SANDERS ON LITHOLAPAXY.
was
discharged
cured
came
on
May.
He
was more
the
operation
for
dispensary for 10 days ; ophthalmia which he got after in the
than for the disease he
came to
be
treated for.
Casey.? Sibby, 56, was suffering 2
years.
was
ed
He
operated
was on
a
Hindoo
male, aged
about
from symptoms of stone for on the 15th May, and
admitted
the
same
day
drams ; the stone was lus. The operation lasted 15 2
; the debris an
weigh-
uric acid calcu-
minutes;
the fol-
noticed the day suclowing symptoms ceeding that of the operation. Has got slight fever, passed water copiously, no pain in the bladder, slight pain in the penis. He was discharged cured on the 21st May, 1882, i. e., 5 days after the operation. Case 8.?Jhoonna Lall, a rich Bania, aged about 40 years, was suffering from symptoms of stone for some years. Every 3 or 4 months he used to pass concretions with the urine, on sounding the bladder a distinct click was felt. The man desired to be operated on at his home in the Bareilly city, where the operation was performed. There was at first some difficulty in passing the lithotrite, for the opening in the glans being small. The instrument went in easily, when a small incision was made in the glans ; the stone was caught and crushed ; it was a very hard calculus (oxalate of lime); the fragments were darkish brown in color, weighing 4 drams. There was free oozing of blood from the wound in the glans, this was stopped with some difficulty by continued pressure by the finger ; more than half The an hour was required to stop the oozing. man got fever and slight cystitis after the operation ; these rapidly passed off from the use of quinine, tincture of steel and buchu. He was able to resume his work after ten days. I frequently see him : he is fat, strong, and healthy, and has had no trouble since the operation. Case 9.?Khaibee Ram, a Hindoo male, aged about 50 years, was admitted on the 2nd July for He was leading a miserable a vesical calculus. life for 2 years ; the pain in micturition was inwere
tense.
round
tions found from
on
A series of minute ulcers and excoriaon the prepuce, evidently caused
With-
the 18th
stopped
this
friction of the foreskin
by
the
fingers
to
THE INDIAN MEDICAL GAZETTE.
70
allay
irritation On the
stone.
lighted up in the bladder by the morning of the 2nd July he was
suffering from retention of urine, the bladder fully distended ; urine drawn off by catheter. On introducing the lithotrite the stone was easily caught and crushed ; the stone was an uric acid calculus ; the fragments were brown in color, weighed 4 drams. Catheter No. 18 passed and the debris removed by aspiration : the operation lasted 30 minutes. The man had slight fever after the operation, which was stopped by quinine. He was discharged cured on the 12th July, i.e., ten days after the operation.
was
Case 10.?Ellahee Bux,
aged
about 85,
Mahomedan. male,
a
admitted
was
the
25th July was suffering from on
with symptoms of stone. He painful and difficult micturition for five months. In this
case
the bladder
was
first filled with
and then the
water
operation was commenced. The stone was easily crushed ; it was a mixed calculus, the central part being formed of uric acid, and the superficial part of phosphatic deposit. The fragments removed by aspiration ; they weighed gvi : the operation lasted warm
25 minutes.
In this
there
case
was
some
en-
of the prostate, for which reason catheter No. 18 could not be passed, catheter No.
largement 16
went in
without
much
difficulty.
Three
after the
days operation he got slight cystitis, from which he got well by the use of steel and quinine. August, Case
He
was
cured
discharged
on
the
3rd
1882.
symptoms of stone for
a
Mahomedan male,
aged about 30 years, was admitted on the 15th September for vesical calculus. He was suffering from symptoms of stone for two months. The urethral end of the glans penis was contracted and so it was first incised by a bistoury; the lithotrite was then easily passed and the stone crush-
4 months.
The urethral
canal
being capacious, there was no difficulty in passing the lithotrite. The stone was caught and crushed; the debris weighed 2 drams. The nucleus was blackish in color, coated externally by brownish colored deposits. It was mixed calculus, partly made of oxalate of lime and partly of uric acid. The operation lasted for 15 minutes. On the 25th September he passed some small fragments of stone with the urine. On the morning of the 30th September the bladder was sounded, when a fragment was detected, this
was
at
once
of
crushed and the debris got rid the bladder by an aspirator.
by washing man got slight cystitis after the operation, this was cured by the use of steel and barley He was discharged cured on the 3rd water. October, 1882. Case 13.?Thakree, a Hindoo male, aged 40 He years, was admitted on the 23rd September. was suffering from symptoms of stone for 8 months. He was twice cut for stone in this dispensary ; out
The
this is the third time he has had stone.
The litho-
easily passed, as the urethral canal was capacious ; the stone caught and crushed with ease, it was a softish calculus ; the fragments weighed 1^ drams; the operation lasted about 15 minutes. On the 30th September, 1882, i. e., seven days after the operation, he complained of much pain in micturition. On passing a big catheter a
trite
was
ragment of stone on
11.?Hafizoollah,
[March, 1883.
detected, which
was
came
eye.
The bladder
solution.
The
was
man was
out
in its
withdrawal of the catheter,
being caught quinine discharged cured on the washed with
6th October, 1882. Case
14.?Budloo,
about 25,
was
male, aged dispensary on the suffering from symp-
Mahomedan
a
admitted into the
27th September.
He
was
uric acid one, very
toms of stone forthree years; sincelasttwo months he was in great agony; the micturition was ex-
small ; the debris weighed 15 grains only. Without the supervention of any unfavourable symptoms he rapidly recovered, and was discharged
cessively painful ; there was slight difficulty in passing the lithotrite, as the patient had slight stricture in the membranous portion of the ure-
ed.
The calculus
cured
on
the 22nd
was
an
September,
1882.
Case 12.?Karimoollah, a Mahomedan male, aged about 80, was admitted into the dispensary on
the 22nd
September.
He
was
suffering from
thra.
On the introduction of the instrument in
the bladder the stone hold and moved
easily by aspiration, was
came
at once within its
crushed it
:
weighed
the
debris
6 drams ;
re-
the
SANDERS ON LITHOLAPAXY.
March, 1883.]
operation lasted 15 ing the operation
minutes. On the
day
succeed-
passed about 16 lbs. of He use of barley water. recovered rapidly, and was discharged cured on the 5th October. No fever nor cystitis after the he
clear urine from the
operation. Case
15.?Rohim
Bux,
Mahomedan
a
male,
about 60 years, was admitted on the 2nd October. He was suffering from symptoms of
aged
stone for
a
On
year.
distinct click
was
sounding
heard. The
the bladder
stone
was
a
crushed
big uric by aspiration; coated calculus, superficially by phosphaounces. tic deposits; the fragments weighed The lithotrite had to be passed in this case six times for crushing the fragments; operation lasted it
debris removed
was
a
acid
for half
3rd
hour.
an
with
mixed
blood and
contained
Hindoo
admitted into the
was
was an
on
male, aged
dispensary
for vesical
uric acid calculus.
quite
no
paininthebladder;
clear.
12th October.?This and the urine found
day tinged
he had
slight fever,
with blood.
From
use of quinine and steel the fever passed off. 17th.?He is free from fever, and the urine is quite normal, no pain in micturition. Discharged cured on the 23rd October, 1882. Case JJ.?Jay Lall, a Hindoo male, aged about
the
pea.
a
mixed with
few
stopped.
cured
Case
the blood in the
of tincture of steel
iotJi.?The urine found
ged
was
particles of stone in the urine. particular pain complained of in micturition.
clots of blood:
no
about
a
8th November.?The urine
was
the
10th Octobet.?No fever; urine
small one, the size of
urine
9th October; micturition was excessively painful. Excoriations found on the prepuce from frequent friction of this part by the finger to allay irritation caused by the stone. The urethral canal being capacious, the lithotrite was easily passed ; the stone caught and crushed; the fragments weighed 4 drs. and 40 grs.; it calculus
labouring soundingthe bladder a small stone was felt almost encysted in the prostate. By the aid of a catheter the stone was pushed back into the bladder where it was crushed by the lithotrite The membranous portion of the urethra was found contracted, and so a large sized catheter could not be passed, a smaller one, No. 12, passed with some difficulty and the debris was removed by aspiration. The stone was a
sand-like
fever,
years ago. Since a month under symptoms of stone;
some
on
use
October, 1882.
16.?Beny, a
for stone
he has been
From
particles slight pain in the bladder, slight pain only complained of in the penis. 6th.?Got fever with shivering; scrotum somewhat swollen, quinine given, by which the fever was stopped, 8th.?Free from fever, urine quite clear, no pain in micturition. Discharged cured on the 17th
20,
once cut
urine
copiously;
has got
of stone:
Case
30 years, was admitted on the 6th November with symptoms of stone in the bladder. He was
No
October.?Passed water
71
quite
Dischar-
clear.
the
15th November, 1882. 18.?Mindaye, a Hindoo male, aged on
was
admitted
19 years, He was suffering from
The micturition
year.
on
the
symptoms of was
about
18th November. stone for
difficult and
a
very
frequent dribbling of urine. The lithotrite passed, stone caught and easily crushed; the fragments weighed 3 drs. anc 20 grs. this was an uric acid calculus; the operation, painful
; there
was
lasted about 15 minutes. igth November.?Vomited four times ; passed only a little urine which was quite clear. The
patient urine
took but little
was
barley
water, and
so
the
scanty.
23rd.?Passed water copiously ; no fever; symptoms of cystitis. Discharged cured on 26th November, 1882. Case 19.?Telock, a Hindoo was
39 years, He 1882.
admitted
was
on
suffering
stone for 6 months.
no
the
male, aged about 29th December,
the
from
The stone
symptoms of
caught
and crush-
by the lithotrite; it was a small calculus; fragments weighed only 15 grs. 30th December.?Passed urine copiously ; no fever. One fragment of stone was found in the urine; no pain in the bladder; slight pain in the ed
the
urethra.
THE INDIAN MEDICAL GAZETTE.
72
urine
yth January.?He passed
mixed with
blood.
of the
[March, 1883' Great force
stone was 8 ounces.
requir-
ed in
8th.?On of stone
the bladder
examining
was
detected, which
lithotrite.
The debris
Discharged
cured
on
was
a
fragment by the
crushed
weighed about 20 ith January, 1883.
the
extracting it. 26th.?Complains of pain region. 28th.?Had
grs.
1
with
fever
in the
hypogastric Wound
shivering.
looking unhealthy. 1st March.?Wound
A
SHORT
HISTORY
WHICH DIED
LITHOTOMY
OF
IN THE
DISPENSARY
DURING
1882.
THE YEAR
Case was
CASES
1.?Nunda, a Hindoo child, aged admitted on the 5th January, 1882.
Has got sloughing. night. 6th.?Slough partly separated. Pulse weak and quick. He is getting low day by day.
about 40, He
8th.?He is very low. on the 9th March, 1882, from exhaus-
was
Died
from symptoms of stone for two years. The micturition was very painful. On sounding
tion.
the bladder
about
suffering
a
The stone
distinct click felt.
re-
by the lateral operation. The wound being small, there was much difficulty in introducing the finger into the bladder. The staff re-introduced, the wound dilated, and then the finger went in with ease. Two stones found moved
made
in the bladder which
were
extracted.
6th.?No bleeding ; vomited three times. 7th.?Has got slight fever. The wound From 8th to
The
12th.
patient
was
Died
on
the
Hindoo male, aged about admitted on the 13th February a
14 years, was with symptoms of stone.
He has been
leading
miserable life for three years. General health much impaired. He was operated on the day he
a
The stone
came
in.
rather
large, weighing
Died from shock Case
ruary.
He
was
was
a
Hindu hill
taken in
suffering
for five years. symptoms have been stone
uric acid calculus,
7 drs. 40 grs. the 14th February, 1882.
on
j.?Dalwooh,
about 18 years,
was an
on
from
the
months.
Lithotrity
small
was a
out
coming 1st
narrow
calculus
and
con-
fever
weighing
with
by
sloughed
of
troublesome from
and
a
part of the wall
faecal
improving. losing flesh
Sth November.?He is
getting
Case
16,
on
matter
is
but
his
every
day
very low.
the
15th November, 1882,
5.?Bellassy,
was
cha-
the wound.
health is not
general and
1
chilliness.
November.?Slough separated,
haustion.
Body almost reduced to a skeleton. He was operated on the 25th February. The stone was a phosphatic calculus of tremendous size ; weight
phosphatic
24-th.?Sloughing extending ; of the rectum
Feb-
turition very painful. There is constant dribbling of urine. Health completely broken down.
being
diarrhoea, which the wound assumed an unhealthy racter, and the edges began to slough.
23rd
Mic-
5th Octowas suffering
at first tried in this case,
13th October.?Complained cough. 20th.?Suffering from bad
Died
greatly aggravated.
the
looking unclean.
aged
Since last 6 months the
was
20 grs. 10th October.?Got
man,
symptoms of
on
tracted, the lithotrite could not be passed, and so the stone was removed by lateral lithotomy.
doing
1882.
13th January,
Case 2.?Chetram,
admitted
was
but the urethral canal
Wound
and died.
years,
ber with symptoms of stone. He difficult and painful micturition for four
dr. and
four times ; became prostate,
4.?Nadir Shah, a Mahomedan male, aged
20
from
It
well.
13th.?Vomited
Case
un-
clean.
Had fev^r last
diarrhoea.
admitted
on
a
Hindoo male, the
from
aged
ex-
about
3rd December, 1882.
from symptoms of stone for The stone was a big one. The patwo years. tient complained of intense pain in making He
was
water. was
suffering
Urine
evidently
mixed with pus. There abscess near the prostatic por-
found an
tion of the urethra.
The stone
was
removed
March,
A MIRROR OF HOSPITAL
.883.!
lateral
operation. It was an uric acid calsuperficially coated with layers of phosphate. It was partially adherent to the wall of by
culus
the bladder. mucous coat
With the out.
The
When it
was
extracted
found attached of
to one
purulent
stone a
gush
weight
of the stone
December.?The
jth pain in the perineum. "jtJi.?Complains of
was
a
part of the
of its surfaces. matter came
6 drs.
patient complaining
pain in the bladder. hypogastric region not diminished ; slight bleeding from the wound. 12th> & 13th.?Pain in the bladder is much increased ; passing mucoid discharge by the wound from cystitis. ijtJi.?Got bad diarrhoea. nth.?Pain
Died
on
much
of
in the
the 21st December from diarrhoea.
PRACTICE.
73
very large. The 4th case litholapaxy, but owing to the stricture lithotomy was performed in preference. The 5th case was almost hopeless from the very severe cystitis the boy was suffering from was
were
well suited for
when admitted. Case
1.?Chokha, a Hindoo male, aged 30, was suffering from symptoms of stone for two years. The urethral canal was capacious. The stone was easily caught by the lithotrite ; it was crushed and the fragments removed by the aid of The stone was a hard one and an aspirator. also large ; the debris weighed 6 drams : the operation lasted about
20
minutes.
The
man was
30th January, 1882, and was disthe 15th February. He had a charged little fever and cystitis after the operation, which passed off rapidly by the use of quinine admitted
on
the
cured
on
and tincture of steel. Case 2.?Sibba, a Hindoo male, aged 60, admitted on the 22nd March. He was suf-
LITHOLAPAXY. By
Surgeon-Major
R. C.
was
Sanders,
m.d.,
F.R.C.S.,
Surgeon, Barcilly. The following cases of Litholapaxy were treated in the Bareilly Dispensary during the year 1882 ; all the cases did well with the exception .of the 5th, in which case a rather tight stricture existed; this was dilated, but unfortunately the got extravasation of urine
and consecutive
which ended fatally. 9th and 10th were operated on by Surgeon P. J. Freyer, M.D. The difficulty experienced was to keep the patients long enough in the dispensary ; but in
pyaemia
Cases
all my
cases
the bladder
days
after the
ment
was
There of
was
operation
washed out
to make
sure no
some
frag-
left in it.
were
during
the .year
treated in the
1882, 52
cases
Bareilly Dispensary. lithotomy history of the fatal cases is given for the sake of comparison with the lithotrity cases ; the mortality during 1882 was exceptionally high. The first case of death took place suddenly on the 8th day after the operation; the cause of death could not be ascertained. The 2nd and 3rd when admitted, cases were in very had health A short
from the symptoms of stone for 15 months. was very painful ; the urine was
The micturition
Civil
man
fering
mixed with
elongated. trite
the prepuce abnormally The stone was crushed by the lithomucus
;
the very day he
on
was
taken in ; the stone
phosphatic calculus, and was crushed with the greatest case ; the fragments weighed 3 The drams ; the operation lasted 20 minutes. man took a large quantity of chloroform, about were noticed 13 drams. The following symptoms No on the day succeedingthat of the operation. fever ; no pain in the abdomen ; very slight pain in the penis ; urine passed copiously. Without any untoward symptoms he came round rapidly,
was
a
and
was
discharged
cured
on
the 28th March,
days after the operation. He left the dispensary and went home on foot. Case 3.?Bhola, a Hindoo male, aged 26, was admitted into the dispensary on 25th March with
seven
all the symptoms of stone, which had been greatly troubling him for a year. The stone was
easily caught an
was
and
man was
by
the lithotrite ; it
The debris
weighed operation lasted for 15 minutes. stopped in the dispensary for 4 days, then discharged cured on the 29th
drams. The
and crushed
uric acid calculus. The
March, 1883.] March.
He had no fever, no cystitis, nor anyother unfavorable symptoms of the operation. Caje 4.?Ramdeen, a Hindoo male, aged 55, was
admitted
April,
1882.
into the dispensary He
toms of stone for
crushed
by
suffering
was
four
years.
the lithotrite ; it
the
on
17th
from the sympThe stone was
was a
big
uric acid
calculus ; the fragments weighed 1 }4 ounces. The operation lasted 25 minutes. To crush the fragments, the instruments had in this case to be introduced into the bladder 7 times ; after each crushing the bladder was washed by an aspira-
April, i. e., on the 6th day after passed some small fragments operation, the 23rd April, on examining the urine. On with his bladder by a sound, a fragment was detected, which was immediately crushed ; it weighed The man had slight cystitis, which 20 grains. He was cured by the use of tincture of steel. was discharged on the 29th April, 1882. Case 5.?Nethram, a Hindoo male, aged 455 was admitted on the 27th April with all the tor.
On the 22nd he
the
symptoms of stone. The man had an urethral stricture, so there was at first much difficulty in the
passing lithotrite
lithotrite.
stricture
terism the
went on
broken and then the The stone
easily.
cathe-
forcible
By
was
easily large sized uric calculus ; the fragments acid weighed one The operation lasted for 30 minutes. ounce. There was rather free bleeding from the urethra in consequence of the structure being ruptured. The man got high fever after the operation, It
and crushed.
caught
was
the prepuce and scrotum
were
the infiltrated tissues all
tually got diarrhoea, 15th May. Case 6.?Summoo, on
the
and
a
was
a
symptoms of extravasation of urine
admitted
much swelled and He
sloughed. sank under
Mahomedan
9th May,
found,
were
1882.
He
it
evenon
male, was
the
was
labour-
ing under symptoms of stone for a year. The stone was easily crushed and the debris removed by aspiration. minutes. The
The
The stone
rapidly,
lasted about 15 uric acid calculus.
operation was an
fragments weighed
out any
about
one
dram.
unfavourable symptoms he and
69
SANDERS ON LITHOLAPAXY.
was
discharged
cured
came
on
May.
He
was more
the
operation
for
dispensary for 10 days ; ophthalmia which he got after in the
than for the disease he
came to
be
treated for.
Casey.? Sibby, 56, was suffering 2
years.
was
ed
He
operated
was on
a
Hindoo
male, aged
about
from symptoms of stone for on the 15th May, and
admitted
the
same
day
drams ; the stone was lus. The operation lasted 15 2
; the debris an
weigh-
uric acid calcu-
minutes;
the fol-
noticed the day suclowing symptoms ceeding that of the operation. Has got slight fever, passed water copiously, no pain in the bladder, slight pain in the penis. He was discharged cured on the 21st May, 1882, i. e., 5 days after the operation. Case 8.?Jhoonna Lall, a rich Bania, aged about 40 years, was suffering from symptoms of stone for some years. Every 3 or 4 months he used to pass concretions with the urine, on sounding the bladder a distinct click was felt. The man desired to be operated on at his home in the Bareilly city, where the operation was performed. There was at first some difficulty in passing the lithotrite, for the opening in the glans being small. The instrument went in easily, when a small incision was made in the glans ; the stone was caught and crushed ; it was a very hard calculus (oxalate of lime); the fragments were darkish brown in color, weighing 4 drams. There was free oozing of blood from the wound in the glans, this was stopped with some difficulty by continued pressure by the finger ; more than half The an hour was required to stop the oozing. man got fever and slight cystitis after the operation ; these rapidly passed off from the use of quinine, tincture of steel and buchu. He was able to resume his work after ten days. I frequently see him : he is fat, strong, and healthy, and has had no trouble since the operation. Case 9.?Khaibee Ram, a Hindoo male, aged about 50 years, was admitted on the 2nd July for He was leading a miserable a vesical calculus. life for 2 years ; the pain in micturition was inwere
tense.
round
tions found from
on
A series of minute ulcers and excoriaon the prepuce, evidently caused
With-
the 18th
stopped
this
friction of the foreskin
by
the
fingers
to
THE INDIAN MEDICAL GAZETTE.
70
allay
irritation On the
stone.
lighted up in the bladder by the morning of the 2nd July he was
suffering from retention of urine, the bladder fully distended ; urine drawn off by catheter. On introducing the lithotrite the stone was easily caught and crushed ; the stone was an uric acid calculus ; the fragments were brown in color, weighed 4 drams. Catheter No. 18 passed and the debris removed by aspiration : the operation lasted 30 minutes. The man had slight fever after the operation, which was stopped by quinine. He was discharged cured on the 12th July, i.e., ten days after the operation.
was
Case 10.?Ellahee Bux,
aged
about 85,
Mahomedan. male,
a
admitted
was
the
25th July was suffering from on
with symptoms of stone. He painful and difficult micturition for five months. In this
case
the bladder
was
first filled with
and then the
water
operation was commenced. The stone was easily crushed ; it was a mixed calculus, the central part being formed of uric acid, and the superficial part of phosphatic deposit. The fragments removed by aspiration ; they weighed gvi : the operation lasted warm
25 minutes.
In this
there
case
was
some
en-
of the prostate, for which reason catheter No. 18 could not be passed, catheter No.
largement 16
went in
without
much
difficulty.
Three
after the
days operation he got slight cystitis, from which he got well by the use of steel and quinine. August, Case
He
was
cured
discharged
on
the
3rd
1882.
symptoms of stone for
a
Mahomedan male,
aged about 30 years, was admitted on the 15th September for vesical calculus. He was suffering from symptoms of stone for two months. The urethral end of the glans penis was contracted and so it was first incised by a bistoury; the lithotrite was then easily passed and the stone crush-
4 months.
The urethral
canal
being capacious, there was no difficulty in passing the lithotrite. The stone was caught and crushed; the debris weighed 2 drams. The nucleus was blackish in color, coated externally by brownish colored deposits. It was mixed calculus, partly made of oxalate of lime and partly of uric acid. The operation lasted for 15 minutes. On the 25th September he passed some small fragments of stone with the urine. On the morning of the 30th September the bladder was sounded, when a fragment was detected, this
was
at
once
of
crushed and the debris got rid the bladder by an aspirator.
by washing man got slight cystitis after the operation, this was cured by the use of steel and barley He was discharged cured on the 3rd water. October, 1882. Case 13.?Thakree, a Hindoo male, aged 40 He years, was admitted on the 23rd September. was suffering from symptoms of stone for 8 months. He was twice cut for stone in this dispensary ; out
The
this is the third time he has had stone.
The litho-
easily passed, as the urethral canal was capacious ; the stone caught and crushed with ease, it was a softish calculus ; the fragments weighed 1^ drams; the operation lasted about 15 minutes. On the 30th September, 1882, i. e., seven days after the operation, he complained of much pain in micturition. On passing a big catheter a
trite
was
ragment of stone on
11.?Hafizoollah,
[March, 1883.
detected, which
was
came
eye.
The bladder
solution.
The
was
man was
out
in its
withdrawal of the catheter,
being caught quinine discharged cured on the washed with
6th October, 1882. Case
14.?Budloo,
about 25,
was
male, aged dispensary on the suffering from symp-
Mahomedan
a
admitted into the
27th September.
He
was
uric acid one, very
toms of stone forthree years; sincelasttwo months he was in great agony; the micturition was ex-
small ; the debris weighed 15 grains only. Without the supervention of any unfavourable symptoms he rapidly recovered, and was discharged
cessively painful ; there was slight difficulty in passing the lithotrite, as the patient had slight stricture in the membranous portion of the ure-
ed.
The calculus
cured
on
the 22nd
was
an
September,
1882.
Case 12.?Karimoollah, a Mahomedan male, aged about 80, was admitted into the dispensary on
the 22nd
September.
He
was
suffering from
thra.
On the introduction of the instrument in
the bladder the stone hold and moved
easily by aspiration, was
came
at once within its
crushed it
:
weighed
the
debris
6 drams ;
re-
the
SANDERS ON LITHOLAPAXY.
March, 1883.]
operation lasted 15 ing the operation
minutes. On the
day
succeed-
passed about 16 lbs. of He use of barley water. recovered rapidly, and was discharged cured on the 5th October. No fever nor cystitis after the he
clear urine from the
operation. Case
15.?Rohim
Bux,
Mahomedan
a
male,
about 60 years, was admitted on the 2nd October. He was suffering from symptoms of
aged
stone for
a
On
year.
distinct click
was
sounding
heard. The
the bladder
stone
was
a
crushed
big uric by aspiration; coated calculus, superficially by phosphaounces. tic deposits; the fragments weighed The lithotrite had to be passed in this case six times for crushing the fragments; operation lasted it
debris removed
was
a
acid
for half
3rd
hour.
an
with
mixed
blood and
contained
Hindoo
admitted into the
was
was an
on
male, aged
dispensary
for vesical
uric acid calculus.
quite
no
paininthebladder;
clear.
12th October.?This and the urine found
day tinged
he had
slight fever,
with blood.
From
use of quinine and steel the fever passed off. 17th.?He is free from fever, and the urine is quite normal, no pain in micturition. Discharged cured on the 23rd October, 1882. Case JJ.?Jay Lall, a Hindoo male, aged about
the
pea.
a
mixed with
few
stopped.
cured
Case
the blood in the
of tincture of steel
iotJi.?The urine found
ged
was
particles of stone in the urine. particular pain complained of in micturition.
clots of blood:
no
about
a
8th November.?The urine
was
the
10th Octobet.?No fever; urine
small one, the size of
urine
9th October; micturition was excessively painful. Excoriations found on the prepuce from frequent friction of this part by the finger to allay irritation caused by the stone. The urethral canal being capacious, the lithotrite was easily passed ; the stone caught and crushed; the fragments weighed 4 drs. and 40 grs.; it calculus
labouring soundingthe bladder a small stone was felt almost encysted in the prostate. By the aid of a catheter the stone was pushed back into the bladder where it was crushed by the lithotrite The membranous portion of the urethra was found contracted, and so a large sized catheter could not be passed, a smaller one, No. 12, passed with some difficulty and the debris was removed by aspiration. The stone was a
sand-like
fever,
years ago. Since a month under symptoms of stone;
some
on
use
October, 1882.
16.?Beny, a
for stone
he has been
From
particles slight pain in the bladder, slight pain only complained of in the penis. 6th.?Got fever with shivering; scrotum somewhat swollen, quinine given, by which the fever was stopped, 8th.?Free from fever, urine quite clear, no pain in micturition. Discharged cured on the 17th
20,
once cut
urine
copiously;
has got
of stone:
Case
30 years, was admitted on the 6th November with symptoms of stone in the bladder. He was
No
October.?Passed water
71
quite
Dischar-
clear.
the
15th November, 1882. 18.?Mindaye, a Hindoo male, aged on
was
admitted
19 years, He was suffering from
The micturition
year.
on
the
symptoms of was
about
18th November. stone for
difficult and
a
very
frequent dribbling of urine. The lithotrite passed, stone caught and easily crushed; the fragments weighed 3 drs. anc 20 grs. this was an uric acid calculus; the operation, painful
; there
was
lasted about 15 minutes. igth November.?Vomited four times ; passed only a little urine which was quite clear. The
patient urine
took but little
was
barley
water, and
so
the
scanty.
23rd.?Passed water copiously ; no fever; symptoms of cystitis. Discharged cured on 26th November, 1882. Case 19.?Telock, a Hindoo was
39 years, He 1882.
admitted
was
on
suffering
stone for 6 months.
no
the
male, aged about 29th December,
the
from
The stone
symptoms of
caught
and crush-
by the lithotrite; it was a small calculus; fragments weighed only 15 grs. 30th December.?Passed urine copiously ; no fever. One fragment of stone was found in the urine; no pain in the bladder; slight pain in the ed
the
urethra.
THE INDIAN MEDICAL GAZETTE.
72
urine
yth January.?He passed
mixed with
blood.
of the
[March, 1883' Great force
stone was 8 ounces.
requir-
ed in
8th.?On of stone
the bladder
examining
was
detected, which
lithotrite.
The debris
Discharged
cured
on
was
a
fragment by the
crushed
weighed about 20 ith January, 1883.
the
extracting it. 26th.?Complains of pain region. 28th.?Had
grs.
1
with
fever
in the
hypogastric Wound
shivering.
looking unhealthy. 1st March.?Wound
A
SHORT
HISTORY
WHICH DIED
LITHOTOMY
OF
IN THE
DISPENSARY
DURING
1882.
THE YEAR
Case was
CASES
1.?Nunda, a Hindoo child, aged admitted on the 5th January, 1882.
Has got sloughing. night. 6th.?Slough partly separated. Pulse weak and quick. He is getting low day by day.
about 40, He
8th.?He is very low. on the 9th March, 1882, from exhaus-
was
Died
from symptoms of stone for two years. The micturition was very painful. On sounding
tion.
the bladder
about
suffering
a
The stone
distinct click felt.
re-
by the lateral operation. The wound being small, there was much difficulty in introducing the finger into the bladder. The staff re-introduced, the wound dilated, and then the finger went in with ease. Two stones found moved
made
in the bladder which
were
extracted.
6th.?No bleeding ; vomited three times. 7th.?Has got slight fever. The wound From 8th to
The
12th.
patient
was
Died
on
the
Hindoo male, aged about admitted on the 13th February a
14 years, was with symptoms of stone.
He has been
leading
miserable life for three years. General health much impaired. He was operated on the day he
a
The stone
came
in.
rather
large, weighing
Died from shock Case
ruary.
He
was
was
a
Hindu hill
taken in
suffering
for five years. symptoms have been stone
uric acid calculus,
7 drs. 40 grs. the 14th February, 1882.
on
j.?Dalwooh,
about 18 years,
was an
on
from
the
months.
Lithotrity
small
was a
out
coming 1st
narrow
calculus
and
con-
fever
weighing
with
by
sloughed
of
troublesome from
and
a
part of the wall
faecal
improving. losing flesh
Sth November.?He is
getting
Case
16,
on
matter
is
but
his
every
day
very low.
the
15th November, 1882,
5.?Bellassy,
was
cha-
the wound.
health is not
general and
1
chilliness.
November.?Slough separated,
haustion.
Body almost reduced to a skeleton. He was operated on the 25th February. The stone was a phosphatic calculus of tremendous size ; weight
phosphatic
24-th.?Sloughing extending ; of the rectum
Feb-
turition very painful. There is constant dribbling of urine. Health completely broken down.
being
diarrhoea, which the wound assumed an unhealthy racter, and the edges began to slough.
23rd
Mic-
5th Octowas suffering
at first tried in this case,
13th October.?Complained cough. 20th.?Suffering from bad
Died
greatly aggravated.
the
looking unclean.
aged
Since last 6 months the
was
20 grs. 10th October.?Got
man,
symptoms of
on
tracted, the lithotrite could not be passed, and so the stone was removed by lateral lithotomy.
doing
1882.
13th January,
Case 2.?Chetram,
admitted
was
but the urethral canal
Wound
and died.
years,
ber with symptoms of stone. He difficult and painful micturition for four
dr. and
four times ; became prostate,
4.?Nadir Shah, a Mahomedan male, aged
20
from
It
well.
13th.?Vomited
Case
un-
clean.
Had fev^r last
diarrhoea.
admitted
on
a
Hindoo male, the
from
aged
ex-
about
3rd December, 1882.
from symptoms of stone for The stone was a big one. The patwo years. tient complained of intense pain in making He
was
water. was
suffering
Urine
evidently
mixed with pus. There abscess near the prostatic por-
found an
tion of the urethra.
The stone
was
removed
March,
A MIRROR OF HOSPITAL
.883.!
lateral
operation. It was an uric acid calsuperficially coated with layers of phosphate. It was partially adherent to the wall of by
culus
the bladder. mucous coat
With the out.
The
When it
was
extracted
found attached of
to one
purulent
stone a
gush
weight
of the stone
December.?The
jth pain in the perineum. "jtJi.?Complains of
was
a
part of the
of its surfaces. matter came
6 drs.
patient complaining
pain in the bladder. hypogastric region not diminished ; slight bleeding from the wound. 12th> & 13th.?Pain in the bladder is much increased ; passing mucoid discharge by the wound from cystitis. ijtJi.?Got bad diarrhoea. nth.?Pain
Died
on
much
of
in the
the 21st December from diarrhoea.
PRACTICE.
73
