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

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