JSTOWKHILLA. DISPENSARY. CASE OF MULTIPLE CALCULUS VESICAE. By Sub-Assistant Surgeon Mohiji Chunder Roy. The following case may be considered interesting, as I have met with a similar one either in the College or in my own practice. I have, indeed, read of surgeons having operated oil cases in which the number of calculi exceeded even a thousand ; but it has been, I believe, the lot of only a few to be personally present at such an operation. Roy Ohund, a fisherman by caste, had about eight years of syphilis and gonorrhoea, attended with sloughago an attack ing of more than a half of the penis, and rendering thereby the canal of the urethra so narrow that it was impossible to introduce even a No. 2 catheter. The stones he had been suffering from for the last six years. When he first came to me, more than four months ago, he had been suffering incontinence of urine. He further told me that now from never
THE INDIAN MEDICAL GAZETTE.
98
and then he gets complete retention, followed by the discharge of small calculi with the urine. As there exists no arrangement whatever in this dispensary for the accommodation of indoor patients ; and as, besides, there are no lithotomy instruments, properly so called, among the dispensary stores, I advised him to go to either Serajgunge or Bogra, where there are no such wants. On the 9th of November last he came to me again, and this time with entire retention of nrine. On examination I found a pretty big piece of stone, about the size of a betelnut, lying in that part of the urethra which lies just behind the scrotum, and thereby proving an obstacle to the passage of the urine. The portion of the urethra just behind this piece of stone had become enormously dilated, and filled with stones of various sizes. The bladder was found quite tense, so as to emit a dull sound on percussion. I at first tried to push the impacted stone back into the bladder, and thus save the man from the immediate danger of a rupture, which, most likely, would have occurred ere he could reach either of the two stations named above?for, as already stated, this dispensary is without means to accommodate in-door patients?but I was unsuccessful in my attempts to do so. I now made an incision through the scrotum on the impacted piece of stone, and removed it, and with it about a couple of ounces of stones, varying in size from that of a betel nut to that of a pea. Three horse-hair sutures were then applied, and the wound dressed, as usual, with carbolic acid mixed with oil. The stones were not counted at the time, a3 I intended to do so, after having them washed, but I was disappointed, for the sweeper who had the stones in charge afterwards told me that they had?nearly nil of them?been stolen. On enquiry I learnt that the people of this country labor under a belief that stones have the property of dissolving stones, and laboring, as they do, under such a belief, they administer The them, rubbed on iron, to patients suffering from stones. wound gave no trouble whatever in healing, and in less than a month after admission the man was perfectly well. He still passes his urine through the newly-made opening; but this, it is expected, could very easily be remedied, had means existed to introduce a catheter, small though it might be, through the canal of the urethra.
Nowkhilla,
the 8th
February 1873.
[AritiL 1,
1873.
THE INDIAN MEDICAL GAZETTE.
98
and then he gets complete retention, followed by the discharge of small calculi with the urine. As there exists no arrangement whatever in this dispensary for the accommodation of indoor patients ; and as, besides, there are no lithotomy instruments, properly so called, among the dispensary stores, I advised him to go to either Serajgunge or Bogra, where there are no such wants. On the 9th of November last he came to me again, and this time with entire retention of nrine. On examination I found a pretty big piece of stone, about the size of a betelnut, lying in that part of the urethra which lies just behind the scrotum, and thereby proving an obstacle to the passage of the urine. The portion of the urethra just behind this piece of stone had become enormously dilated, and filled with stones of various sizes. The bladder was found quite tense, so as to emit a dull sound on percussion. I at first tried to push the impacted stone back into the bladder, and thus save the man from the immediate danger of a rupture, which, most likely, would have occurred ere he could reach either of the two stations named above?for, as already stated, this dispensary is without means to accommodate in-door patients?but I was unsuccessful in my attempts to do so. I now made an incision through the scrotum on the impacted piece of stone, and removed it, and with it about a couple of ounces of stones, varying in size from that of a betel nut to that of a pea. Three horse-hair sutures were then applied, and the wound dressed, as usual, with carbolic acid mixed with oil. The stones were not counted at the time, a3 I intended to do so, after having them washed, but I was disappointed, for the sweeper who had the stones in charge afterwards told me that they had?nearly nil of them?been stolen. On enquiry I learnt that the people of this country labor under a belief that stones have the property of dissolving stones, and laboring, as they do, under such a belief, they administer The them, rubbed on iron, to patients suffering from stones. wound gave no trouble whatever in healing, and in less than a month after admission the man was perfectly well. He still passes his urine through the newly-made opening; but this, it is expected, could very easily be remedied, had means existed to introduce a catheter, small though it might be, through the canal of the urethra.
Nowkhilla,
the 8th
February 1873.
[AritiL 1,
1873.
