Case No. 1.?Hoossain Bux, aged 49, was admitted to the dispensary on the 8tli March, suffering from symptoms of stone for the past five months. Under chloroform a small stone was seized and crushed ; during the aspiration the uncmslied stones, each the size of a large pea, came through the tube ; after the aspiration careful sounding detected nothing. March 10th.?Free from pain ; urine tinged with blood. 11 th.?Slight pain ; urine still slightly tinged with ?

blood. March \2th.?Free from ? ?

pain ; micturition normal. \7th.?Carefully examined, no debris could be felt. 2Lst.?Discharged cured. No. 2.?Sumer Sing, age 32, admitted on June 4th,

Case 1880. Has had symptoms of stone for the past two months. Under chloroform the stone was crushed and the debris aspirated. June oth.?A few particles of sand passed with the urine : is free from pain : micturition normal. June 6th.?Quite well ; insists on going home as he feels so well ; no debris could be felt on careful examination. Case J\ro. 3.?Dorug Pal Sing, aged GO, 25th, suffering from symptoms of stone. He

in

.June under chloroform and the stone crushed ; the debris being also caught and crushed two or three times : during the aspiration some large pieces were heard to rattle against the tube : the Lithotrite was again passed and the fragments crushed; all were not removed, so the lithotrite was passed for the third time and the bladder again aspirated, after which careful The dried debris weighed sounding detected nothing. came

was

on

placed

seventy-four grains.

June 2Gth.?Quite well except slight fever; micturition normal. July 1 st.?Slight fever: no sign of any fragments on careful so.rnding. July 2nd.?Discharged cured. Case No. 4.? Badri Nath, aged 50. came to the hospital on the 6th July, suffering from stone; the stone was crushed under chloroform and the fragments aspirated. July 7th, 1880.?Urine passed in full stream, slighly tinged with blood. July 9th.?States he is quite well ; wishes to go home as he finds a difficulty about his food ; promises to return in a week. July 15th.?Returned this day : micturition is painless : bladder washed out, found to be free from sediment. Case No. 5.?Siba, aged 28, came to hospital on the mornof the 19th August 1880. with symptoms of stone. He was chloroformed and the bladder aspirated : all debris was removed. 2oth.?Bladder distended from retention of urine ; catheter passed and the urine drawn off ; found to be clear and free from sediment. 21 st.?Passing water freely ; no pain. 24th.?Fit for discharge : bladder carefully examined ; no debris present. Case No. 6.?Hoolassy, aged 32, admitted on the morning of the 18th October, suffering from symptoms of stone for the last four months ; the stone was crushed and the fragments aspirated, all debris being removed. October 20th.?Urine tinged with blood : feverish ;

ing

slightly

A MIRROR OF HOSPITAL PRACTICE. LITHOTRITY WITH RAPID EVACUATION OF THE DEBRIS. By Surgeon R. C. Sanders, Civil Surgeon, Sareilly.

During the past year certain cases of stone have been treated by Bigelow's method in the Bareilly Dispensary. At first only small stones were operated on ; in future I am in hopes of greatly discarding Lithotomy for the new operation. The following are my cases up to present date, the notes of which were carefully taken by Baboo Beliari Lall Ghose. The tenth case was operated on by Dr. Blood of the 37th N. I., under whose care the sepoy was.

bowels constipated. 21st.?Fever with shivering : no pain in bladder, micturition is normal. 25th.?Free from pain ; micturition normal. 28th.?Bladder washed out ; no fragments found. Dis-

charged

cured.

Case No. 7.?Mohammad Isaq, aged 58, admitted on the 11th October : health bad, suffering from symptoms of stone for the past five years : very asthmatic, and the base of the lungs was much congested. A large stone was seized and crushed and the debris crushed several times ; the lithotrite was introduced four times, and the dried debris weighed 1! ounces : the operation could not be completed on account and general lividity of the surface of the of *

failing pulse body. 12th.?Micturition painless ; urine slightly tinged with blood. Cough troublesome, especially at night. 13th.?Feverish, pulse quick, breathing short and hurried ; cough very troublesome ; slight pain in bladder ; urine quite clear, and passed without pain. 5 ?Morning free from fever ; micturition normal.

p. m,

Fkbkuaky I,

A MIRROR OP HOSPITAL PRACTICE.

1881.]

from fever, which came on at 2 P. M., attended with troublesome cough and difficult breathing. 15th.?Is this morning free from fever ; during night passed a few fragments of stone ; urine stained with blood, micturition painful ; cough still troublesome. 16th.?Pain much worse ; urine mixed with blood and passing in drops with straining; no fever, but cough very troublesome : was of opinion that it was best to remove all ragments at once ; he was therefore carefully chloroformed and -J oz. of fragments removed, the bladder being then quite free from debris. 17th. Better in every way ; micturition easy ; urine clear. 18th.?His urine is quite clear, and he has no pain of any kind in the bladder, but his general state is much worse. Temperature high, pulse quick and feeble, tongue dry ; dulness with line crepitation over lower part of base of both lungs. > P. M.?More feeble, dulness increasing rapidly : has passed urine freely during the day with no symptoms of bladder

?-Suffering

?

irritation. 19?A.?Died this day from pneumonia. Case No. 8.?Hoolassy, aged 32, admitted with stone on the 18tli October. A small stone was discovered in the prostatic urethra, which was pushed into the bladder by the Lithotrite, there crushed, and the debris aspirated. 20tk.?Slight fever yesterday ; bowels constipated ; micturition normal.

?

25th.?Free from fever ; micturition normal. be

28th.?Discharged

cured

:

j-.*'

bladder examined and found to

quite empty.

Case No. 9.?Balkrishun, aged 35, admitted on the morning of the 10th November. Has been suffering from stone for the last five yfiars ; the stone was well broken by the lithotrite and the debris aspirated ; the operation lasted one hour, and the debris weighed one and a half ounces. As it was not considered advisable to persist longer, some large pieces were left in the bladder; 15 minutes after the operation had a severe rigor followed by fever. 12 noon.?No pain in the bladder ; passing water freely. 4 p. m.?Temperature 1004?, 104. pulse Skin moist ; urine passing in drops mixed with

blood. November ll?A.?No fever ; passing urine freely, which is

slightly tinged in the urethra.

with blood

:

complains

of

slight burning pain

12th.?20 grains of debris passed with the urine fever. 13?A.?3

grains

of debris

14th.?Slight mucous

passed.

15?A.?Passing

much

passed

; no

:

fever and no

free from

pain.

discharge with three small fragments mucus

with the urine.

Lithotrite three

again passed; fragments well comminuted and drachms of debris removed. 16th.?No symptoms except irritation of the urethra

: urine mixed with blood. 17th.?Slight fever with rigors ; suffering much from thirst, with pain in the bladder : morning temperature 99'4?, evening 100-6?. 18?A.?Morning temperature 99? ; urine passing freely : has much pain in the penis ; evening temperature 100'6?. 20th.?Temperature normal : free from pain. 22nd.?Urine mixed with a little mucus, on washing out the bladder some fragments were felt which were at once crushed under chloroform and the debris removed : fragments weighed 2 drachms. 23rd.?Slight fever : no bad symptoms. 27th.?Slight mucus in the urine : is walking all over the place and cooking his food. December 7th.?Bladder washed out; free from any particles of stone. Discharged cured. Total weight of fragments 1 oz., 7 drachms and 26 grains. Case No. the 4th 9.?Sumphul Sing, aged 40, admitted on from the December ; is a sepoy, and has been sent back : Kurram. Has had symptoms of stone for the past ten months N. was brought to the I., Dispensary by Dr. Blood of the 37th and seized who operated on him. A very hard stone was crushed and the fragments were repeatedly broken, the bladder was aspirated and all debris carefully removed. Weight of dried debris 3 iii. 5th.?No pain ; temperature normal; pulse 80 ; eight grains of sand passed in the urine. 6th.?Micturition normal: states he is perfectly well. \2th.?:Has had no bad ; urine clear and free from .

sediment.

symptoms

55

14th.?Penis sore from prepuce having been slit: remains hospital to have his bladder washed out. Case No. 11.?Heera Lall. aged 40, admitted on the morning of the 9th December 1880 ; has been suffering from stone for one year, the stone was crushed and the debris removed by the aspirater. Dried debris weighed one drachm. lQth.?No pain except in the penis, which is tender. 11 th.?Quite well ; micturition normal. 12th.?Wishes to go home ; is allowed to do so on the understanding that he will return in a week's time to have the bladder washed out, which he promises to do. These are my cases up to date. The operation is tedious and troublesome to the operator, but I feel confident it will have a great success in this country. in

Lithotrity with Rapid Evacution of the Debris.

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