A MIRROR OF HOSPITAL PRACTICE. ? .
CASES OF LITHOLAPAXY. By
/
Surgeon-Major r. c. Sau-nders, Civil Surgeon, Bareilly.
Since my last communication to tlie Indian Mcdical Gazette the following cases of stone have been operated on by me, after Bigelow's method :? Case 12.?Khooshally, aged 40, admitted on the 14th December 18S0 ; he has had symptoms of stone for the past year, under chloroform the stone was crushed and the debris removed by aspiration. The lithotrite was introduced three times. The dried fragments weighed 2g drachms. 1Gth.?Passed a few particles of sand ; is passing his urine in full stream without pain. 17th.?Is quite well; wishes to return to his home. 18M.?Bladder washed out; no fragments remaining. Discharged cured. Case 13.?Goongoo, aged 70, admitted onthe2Gth December 1880; suffering from stone for 15 mouths; very feeble,
THE INDIAN MEDICAL GAZETTE.
192
health very bad. Under chloroform the stone was crushed and 4 drachms of debris removed ; the operation lasted 20 minutes ; the stone was a very hard one. 27th.?Complains of pain in the bladder ; has passed no water since the operation ; catheter introduced and bladder found empty. 28th.?Very low and feeble ; no urine secreted ; has some difficulty in breathing. 29th.?Died this day from unemic poisoning. Case 14.?Totaram, aged 25 ; has been suffering from symptoms of stone for a few weeks. On passing the litliotrite a small stone was caught and crushed, the fragments only weighed a few grains. He was in hospital just six days, and had an uninterrupted recovery. Case 15.?Sokliee Chamar, aged 44, was admitted into the Hurdoi Dispensary on the morning of the 7th January 1881. stone for the past He states that he has bad symptoms of eleven months- The stone was crushed and all fragments removed by aspiration. Debris weighed 6 drachms. January 8th.?Slightly feverish ; has been passing water freely without pain ; urine clear, free from sediment. 9th.?No fever ; tongue clean ; micturition normal in every way. 11 th.?States he is quite well. 12th.?Went to his home yesterday, returned again this morning ; micturition painless ; health good. 13th?Bladder aspirated; no fragments. Discharged cured. Case 16.?Kumroo, aged 45, mali, admitted on the 11th January 1881 ; has been suffering from stone for the last 6 months, during which time he has passed two small stones. The stone was crushed and the debris removed ; when dried it weighed 7 drachms. 12th January.?Slightly feverish last night; complains of pain over the bladder ; urine contains blood clots and is of high color. 13th.?No fever this morning ; has slight pain over the bladder ; and complains of difficulty in making water ; bowels costive. 14th.?No pain nor tenderness ; is free from fever ; health
good.
[July 1,
1881.
1881 ; lias been suffering from stone for the past three years ; the stone was avery large one, and the lithotrite was introduced six times before the whole of it was crushed, the operation lasted 45 minutes, and the fragments weighed 1 ounce 8 drachms and 15 grains. The stone was an uric acid one. ?Urine free from blood ; 10 small fragments of stone have passed ; slight pain in the urethra. Tongue foul, covered with thick white fur ; pulse quiet ; skin warm. 11 th.?Penis swollen and painful ; urine passing in large quantity, is quite clear and free from blood or mucus ; one small fragment passed. \2th.?Three stools ; had slight fever last night. 13th?The fever has not left him ; bowels well opened ; pain in penis is much the same. 1 Uh.?Fever less ; tongue still covered with thick fur; swelling and pain in the penis less ; no pain in the bladder ; urine passing freely and is quite clear. loth.?Vomited three times ; fever is much less this morning ; tongue moist but unclean ; 3 stools ; slight pain in micturition. 16th.?No. stool; pulse normal ; tongue is still unclean. 17th.?One stool, no fever ; passing water without pain. 20th.?Suffering from bad diarrhoea, stools loose and most offensive. Tongue very foul, dry, and brown in centre ; no fever, vomited bilious matter twice. 21s?.?Diarrhoea better, but his tongue is still bad. 22nd.?'Has passed two loose stools ; mind affected ; tongue brown and dry ; teeth covered with sordes ; suffering much from hiccough; still passing urine freely and without '
pain.
23rd.?Condition much the same as yesterday; slightly weaker, and hiccough more troublesome.
24th.?Died this day, no post-mortem could be obtained. Case 20.?Punny, aged 40, was admitted on the 18th April 1881 ; has been suffering from symptoms of stone for one year ; the stone was crushed and the debris removed, which when dried weighed 72 grains. 19th.?Slight pain, no fever ; urine mixed with blood ; a few particles of sand have passed in the urine. 20th.?Slight fever with shivering; urine clear and free from sediment ; no pain in penis or bladder. 2\st.?No fever ; micturition normal, passed in full stream without pain. 23rd.?Discharged cured. Case 21.?Ajub Khan, aged 75, was admitted on the 25th April, and has been suffering from stone for 8 months ; the dried debris weighed one drachm. 2Gth.?Passing water freely, has slight pain in the penis ; no fever. 21th.?Slight pain in penis, but the urine is clear, and he has no fever. May 1 st.?Free from pain and fever, doing well. 3rd.?Discharged cured. Case 22.?This was a very interesting case in a young girl. 26th April 1881 ; stated to Sibta, aged 4, was admitted on the one year ; micturition was have had symptoms of stone, for of the rectum. very painful and accompanied with prolapse and crushed, the seized Under chloroform a stone was them awkward to handle. length of the instruments made The stone was very hard, and considerable power was neces2 drachms 40 grains. sary to crush it. The fragments weighed and the skin is hot and '21 til.?Slight pain in the bladder, the urine. feverish ; bowels costive ; no blood in 29th.?No pain ; micturition normal ; free from fever. home as she is so well ; 30th?Her parents wish to take her has no pain nor any sign of fever. Discharged cured. wa3 admitted on the 14th Case 23.?Salick Ram, aged 40, of May 1881 ; has had symptoms of stone for 2 years. He was lithotrised and the fragments removed, their weight was 1 drachm and 40 grains, the operation lasted 20 minutes, the lithotrite was with difficulty removed owing to debris the mucous membrane being impacted between the blades ; of the spongy urethra was lacerated.^ 15th.?Passing water freely which is mixed with blood; free except in the penis; three small fragments from _
16th.?Health good, micturition normal ; bladder washed out: two small pieces of stone were removed. 19th.?Quite free from all pain ; states he is all right and wants to go home. 21 st.?Discharged cured. Case 17.?Doorjun, aged 50, admitted on 12th January 1881; has been suffering from stone for the past 17 months ; the stone was crushed this morning and the fragments, removed ; debris weighed 6? drachms. 10 A. M.?Patient shivering ; still stupid from the effects of chloroform. 2^ p. M.?Pulse good ; no further shivering since he has been brought out into the sun ; feels comfortable. 4 p. M.?Feverish ; passing water with straining and but a small quantity at a time ; urine tinged with bloou. 13^/i..?No fever, pulse quiet ; has a little tenderness over 2 small fragments the pubic region ; no pain in micturition ; ^
.
passed.
14th.?No fever, urine clear ; 2 fragments passed. 15th.?General health good ; bladder washed out with Quinine solution ; no fragments detected. 18?/
CASES OF LITHOLAPAXY. By
/
Surgeon-Major r. c. Sau-nders, Civil Surgeon, Bareilly.
Since my last communication to tlie Indian Mcdical Gazette the following cases of stone have been operated on by me, after Bigelow's method :? Case 12.?Khooshally, aged 40, admitted on the 14th December 18S0 ; he has had symptoms of stone for the past year, under chloroform the stone was crushed and the debris removed by aspiration. The lithotrite was introduced three times. The dried fragments weighed 2g drachms. 1Gth.?Passed a few particles of sand ; is passing his urine in full stream without pain. 17th.?Is quite well; wishes to return to his home. 18M.?Bladder washed out; no fragments remaining. Discharged cured. Case 13.?Goongoo, aged 70, admitted onthe2Gth December 1880; suffering from stone for 15 mouths; very feeble,
THE INDIAN MEDICAL GAZETTE.
192
health very bad. Under chloroform the stone was crushed and 4 drachms of debris removed ; the operation lasted 20 minutes ; the stone was a very hard one. 27th.?Complains of pain in the bladder ; has passed no water since the operation ; catheter introduced and bladder found empty. 28th.?Very low and feeble ; no urine secreted ; has some difficulty in breathing. 29th.?Died this day from unemic poisoning. Case 14.?Totaram, aged 25 ; has been suffering from symptoms of stone for a few weeks. On passing the litliotrite a small stone was caught and crushed, the fragments only weighed a few grains. He was in hospital just six days, and had an uninterrupted recovery. Case 15.?Sokliee Chamar, aged 44, was admitted into the Hurdoi Dispensary on the morning of the 7th January 1881. stone for the past He states that he has bad symptoms of eleven months- The stone was crushed and all fragments removed by aspiration. Debris weighed 6 drachms. January 8th.?Slightly feverish ; has been passing water freely without pain ; urine clear, free from sediment. 9th.?No fever ; tongue clean ; micturition normal in every way. 11 th.?States he is quite well. 12th.?Went to his home yesterday, returned again this morning ; micturition painless ; health good. 13th?Bladder aspirated; no fragments. Discharged cured. Case 16.?Kumroo, aged 45, mali, admitted on the 11th January 1881 ; has been suffering from stone for the last 6 months, during which time he has passed two small stones. The stone was crushed and the debris removed ; when dried it weighed 7 drachms. 12th January.?Slightly feverish last night; complains of pain over the bladder ; urine contains blood clots and is of high color. 13th.?No fever this morning ; has slight pain over the bladder ; and complains of difficulty in making water ; bowels costive. 14th.?No pain nor tenderness ; is free from fever ; health
good.
[July 1,
1881.
1881 ; lias been suffering from stone for the past three years ; the stone was avery large one, and the lithotrite was introduced six times before the whole of it was crushed, the operation lasted 45 minutes, and the fragments weighed 1 ounce 8 drachms and 15 grains. The stone was an uric acid one. ?Urine free from blood ; 10 small fragments of stone have passed ; slight pain in the urethra. Tongue foul, covered with thick white fur ; pulse quiet ; skin warm. 11 th.?Penis swollen and painful ; urine passing in large quantity, is quite clear and free from blood or mucus ; one small fragment passed. \2th.?Three stools ; had slight fever last night. 13th?The fever has not left him ; bowels well opened ; pain in penis is much the same. 1 Uh.?Fever less ; tongue still covered with thick fur; swelling and pain in the penis less ; no pain in the bladder ; urine passing freely and is quite clear. loth.?Vomited three times ; fever is much less this morning ; tongue moist but unclean ; 3 stools ; slight pain in micturition. 16th.?No. stool; pulse normal ; tongue is still unclean. 17th.?One stool, no fever ; passing water without pain. 20th.?Suffering from bad diarrhoea, stools loose and most offensive. Tongue very foul, dry, and brown in centre ; no fever, vomited bilious matter twice. 21s?.?Diarrhoea better, but his tongue is still bad. 22nd.?'Has passed two loose stools ; mind affected ; tongue brown and dry ; teeth covered with sordes ; suffering much from hiccough; still passing urine freely and without '
pain.
23rd.?Condition much the same as yesterday; slightly weaker, and hiccough more troublesome.
24th.?Died this day, no post-mortem could be obtained. Case 20.?Punny, aged 40, was admitted on the 18th April 1881 ; has been suffering from symptoms of stone for one year ; the stone was crushed and the debris removed, which when dried weighed 72 grains. 19th.?Slight pain, no fever ; urine mixed with blood ; a few particles of sand have passed in the urine. 20th.?Slight fever with shivering; urine clear and free from sediment ; no pain in penis or bladder. 2\st.?No fever ; micturition normal, passed in full stream without pain. 23rd.?Discharged cured. Case 21.?Ajub Khan, aged 75, was admitted on the 25th April, and has been suffering from stone for 8 months ; the dried debris weighed one drachm. 2Gth.?Passing water freely, has slight pain in the penis ; no fever. 21th.?Slight pain in penis, but the urine is clear, and he has no fever. May 1 st.?Free from pain and fever, doing well. 3rd.?Discharged cured. Case 22.?This was a very interesting case in a young girl. 26th April 1881 ; stated to Sibta, aged 4, was admitted on the one year ; micturition was have had symptoms of stone, for of the rectum. very painful and accompanied with prolapse and crushed, the seized Under chloroform a stone was them awkward to handle. length of the instruments made The stone was very hard, and considerable power was neces2 drachms 40 grains. sary to crush it. The fragments weighed and the skin is hot and '21 til.?Slight pain in the bladder, the urine. feverish ; bowels costive ; no blood in 29th.?No pain ; micturition normal ; free from fever. home as she is so well ; 30th?Her parents wish to take her has no pain nor any sign of fever. Discharged cured. wa3 admitted on the 14th Case 23.?Salick Ram, aged 40, of May 1881 ; has had symptoms of stone for 2 years. He was lithotrised and the fragments removed, their weight was 1 drachm and 40 grains, the operation lasted 20 minutes, the lithotrite was with difficulty removed owing to debris the mucous membrane being impacted between the blades ; of the spongy urethra was lacerated.^ 15th.?Passing water freely which is mixed with blood; free except in the penis; three small fragments from _
16th.?Health good, micturition normal ; bladder washed out: two small pieces of stone were removed. 19th.?Quite free from all pain ; states he is all right and wants to go home. 21 st.?Discharged cured. Case 17.?Doorjun, aged 50, admitted on 12th January 1881; has been suffering from stone for the past 17 months ; the stone was crushed this morning and the fragments, removed ; debris weighed 6? drachms. 10 A. M.?Patient shivering ; still stupid from the effects of chloroform. 2^ p. M.?Pulse good ; no further shivering since he has been brought out into the sun ; feels comfortable. 4 p. M.?Feverish ; passing water with straining and but a small quantity at a time ; urine tinged with bloou. 13^/i..?No fever, pulse quiet ; has a little tenderness over 2 small fragments the pubic region ; no pain in micturition ; ^
.
passed.
14th.?No fever, urine clear ; 2 fragments passed. 15th.?General health good ; bladder washed out with Quinine solution ; no fragments detected. 18?/
