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Stone.
Stone in the Bladder.—W e
have had 33 cases admitted with this disorder, of
whom 9 have died. As there are many points of interest con-
nected with these cases, I shall enter somewhat into detail concerning them. The admis-
sions were a little more than 3 per cent. of the whole number of admissions, and the mortal-
ity (9, much higher than usual in this hospital) was the same as from Phthisis, viz.,
5.45 per cent. of the whole mortality. Of the 33 cases, 29 were operated on ; 23 by lithot-
o m y , a n d 6 * b y l i t h o t r i t y . F o u r w e r e n o t o p e r a t e d o n , e i t h e r b e i n g u n f i t c a s e s o r
declining to submit to operation. One of the 9 deaths was among these four unfit cases,
A very old man suffering from diarrhoea, who died a few days after admission. The other
8 d e a t h s w e r e a l l A f t e r t h e c u t t i n g o p e r a t i o n .
Lithotomy.
I have not many remarks to make about lithotomy. Of the eight cases that
died, 5 were men varying in age from 50 to 90. One was only
35, but the stone was 4 ozs. in weight. Another was a very sickly child aged 9, who
died of diarrhoea after the operation. Of the remaining case, I regret to say, the record
is imperfect.
With regard to lithotrity, I paid a good deal of attention to the subject when
Lithotrity. at home, and was much pleased with' the lithotrite now used by
Sir Henry Thompson, who has satisfactorily shown that lithotrity can only be habitu-
ally successful when performed with an instrument instantaneously convertible, while in
the bladder, from a sliding to a screwing movement. This desideratum is perfectly
supplied in his instruments, of which I brought a set out with me, and with which I
have operated with complete success on 5 patients during the past year. The first case
(Register IV, page 304) was a man of the name of Nazur, œt. 60. He was admitted in
February, and was under treatement 36 days, during which time he was operated on
seven times at intervals of from 4 to 6 days. At the end of this time he left the
hospital of his own accord, much relieved, seventy grains of stone having come away, but
some small fragments I know were still remaining in his bladder.
He came back in August (Register XII, page 322). He was this time 23 days
under treatment, during which he was operated on 4 times at intervals varying from four
to seven days, and was discharged apparently cured, 39 grains of calculous matter having
escaped. The stone was phosphatic. I have since enquired about this man at his village,
and though I did not see him, as he was absent from home, his friends informed me that
he was quite well.
The second case was Emam Deen, œt. 26, with a small phosphatic stone (Hospital
Register No. IV, page 418). He was under treatment 22 days, and was operated on four
times at intervals of 4 days. The calculous matter that escaped weighed 52 grains.
The third case (Register XII, page 329) was a very old man, Morad Shah, said to
be 90, in whom any cutting operation would have been exceedingly dangerous. The
stone was phosphatic. He was under treatment 45 days, and was operated on 9 times
at intervals varying from 3 to 6 days ; the quantity of stone collected was 94 grains. He
was discharged at his own request, still suffering from some irritability of the bladder,
but no stone could be detected on sounding.
The fourth case, Backtawur, œt. 40 (Register. XII, page 336), was under treatment
17 days . He was operated on twice at an interval of 3 days. The quantity of stone col-
lected was grains 10.
The fifth case (Register X, page 62) was also a man œt. 40, Vallee Dad, who had
a phosphatic stone 1/3i n c h i n t h e d i a m e t e r , i n w h i c h i t w a s c a u g h t b y t h e l i t h o t r i t e . H e
was under treatment about 24 days altogether, and was lithotritised twice at an interval
of three days ; seven grains of calculous matter only was collected. In these cases I have
given the quantities of calculous matter that were collected either withdrawn between
.
* The number of persons operated on by lithotrity was five, but, as one of the five (Nazur) was
discharged in March and admitted again in August, the monthly returns of course show two cases, though the
patient was the same.