April 1,
he
\J
???
EXPERIENCES
OF
that he had remained
persistently declared
perfectly well,
and been able to run, jump, and perform any active exercise after his discharge on March 4th, till a fortnight or three weeks previous to his second admission on October 19th.
ORIGINAL COMMUNICATIONS. INDIAN
G9
INDIAN EXPERIENCES OF LITIIOTRITY.?BT J. B. S CRT YEN.
i860.]
LITIIOTRIIY.
I have heard the
raised to
objection
lithotrity,
that there
could be no certainty of the last fragments having been removed. That this is more difficult to ascertain than in lithotomy, must be admitted; but, surely, the total absence of symptoms for seven months is sufficient evidence of cure. Neither operation, of course,
By J. B. Sckiven,
Principal, Lahore Medical School. Having published in the numbers of the Indian Mcdicalcan alter the diathesis, and it must bo well known to all surGazette for August and October, 1868, a brief account of thirtygeons of large experience in lithotomy that it is no unusual three cases of lithotrity at the medical school hospital at for a second stone to form after the first has been removed thing Lahore, I now add a tabular statement of seven more, makingby a cutting operation. the number forty since 1861, of which 18 have been during the
last two years, 1867 and 1S68. All of these seven were successful except one, that of an old man, who could not have lived He got diarrhoea soon after the under any circumstances. and
operation, referable After
to
gradually sank, without
new
any
symptoms
the bladder. his
death,
kidneys
were
found
enlarged
and
their
fatty,
Quantity
of
Average number oT pieces crushed on the occasions on which the time
was
noted^
pelves dilated, inflamed, and containing pus. In the bladder there were five stones, varying from 1 inch to 1 ? inch in their
Average time
long diameter; one of these had been broken into largo fragments by the lithotrite. The bladder was ?much thickened,
operations.
and
injected ; the middle lobe of the greatly enlarged, and projected upwards into the bladder. The mucous membrane of the urethra was ulcerated, and even in a sloughy condition in some places ; and, about its middle, was a faceted calculus, half an inch in diameter. The its mucous membrane
prostate
was
bladder contained about six
of urine.
ounces
strument
was
the inin the
bladder in the
same
of operations [Number in which the time the instrument was in the bladder was noted.
Result.
The other six
ordinary ones, and the stones of moderate size. principal object in the present communication is to supply a deficiency in the former papers, in which, it will be remembered, I had no very useful information to supply from my own practice as to the time the lithotrite ought to remain in cases
detritus
collected.
were
One
the bladder.
consideration, the time has been carefully noted in several instances, so that some deductions can be drawn. These are certainly not too favourable; for, in some of the patients, especially Kahun Sing, there was unusual difficulty in catching the stone, which was generally found sunk down into a hollow behind the prostate gland. The tabular form given below, is the same as in the last paper, except that the column of remarks has been cut up into three, In the
seven
referring to
cases
now
the time the instrument
seconds, and unusual period. Peer Buksh
seconds,
the
longest
was
in the bladder.
4 minutes and 37
cases
seconds,
which
gives the
15 seconds to each
Size of Stone.
piece.
period was eight days, and the average being twenty days, which,
operation.
was
Sex.
period
the shortest
Date of first
a
that these cases were under treatment was less than is usual in lithotomy, with the exception ?f the last case, Ivhoda Buksh. Taking the six cases that
recovered,
Number of operations.
I
very It appears from the table that in the case of five pieces were crushed in 1 minute and 15
Furthermore,
Duration of treatment.
under
*nay mention here that the shortest time in these 45
Composition of Stone.
Age.
the
longest I believe, is thirty-seven, less than the average of any successive six cases of lithotomy that could bo collected from the records of any hospital in India, counting from the day of operation till the wound in the perineum was completely healed. Thus, one great objection raised to the practice of lithotrity in this country, viz.,
the protraction of the treatment, did not exist in these cases, and, with good instruments and proper selection of cases, seems to me likely to disappear in the vast majority of instances. The fifth case, Jaga, was once in hospital before ; but there is no doubt that on this second occasion he was suffering from a fresh stono, and not from any remnant of the former one, for
Name.
O
a
I
e. r
if Is.
3 t?
M
1
C3
3
Number.
Lahore, February 18th, 18C9.
p4
2