238 AROUND THE WORLD VIA INDIA. 



treated by litholapaxy made excellent and speedy re- 

 coveries. The largest stone removed by this operation 

 weighed 935 grains and the average hospital life for 

 each case was 4.18 days. The 3 cases operated on by 

 lithotomy were unfit for any other operation, and the 

 patient who died after operation was a man worn out 

 by the disease complicated by cystitis and renal trouble ; 

 his stone weighed 1.072 grains. Perineal lithotrity 

 was reserved for cases in which a lithotrite large enough 

 to crush the stone could not be passed by the urethra. 

 The' operation was performed by making, on a small 

 staff, a median incision just large enough to permit a 

 sufficiently large lithotrite to enter the bladder, one 

 direct stabbing incision going straight into the blad- 

 der on a grooved staff was sufficient. The largest stone 

 weighed 1,501.5 grains and the average stay in the hos- 

 pital was 12.5 days. 



SPLENIC ANEMIA. 



In the medical wards of this hospital I had an op- 

 portunity to examine four cases of so-called splenic 

 anemia, that is, a disease characterized by great en- 

 largement of the spleen with progressive anemia. All 

 the patients were young men, natives, from 18 to 35 

 years of age. In all the abdomen was very much en- 

 larged and pendulous, and through the thin abdominal 

 walls the outlines of the enormously enlarged spleen 

 could be very plainly traced. In some of these cases the 

 spleen extended beyond the median line and its lower 

 border almost reached the level of Poupart's ligament. 

 "In two of the eases the liver was also markedly en- 

 larged. Emaciation and a profound anemia in all of 

 them were the most prominent clinical features. I 

 was informed that this disease generally yields in the 

 course of time to a sulphate mixture which is used in 

 this hospital, of which the most active ingredients are 

 sulphate of quinin and sulphate of iron. 



During my visit to the Bengal Medical College, Cal- 



